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NPI Code Detail

MEDICARE: LORI HEAVLIN

MEDICARE: LORI HEAVLIN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1171M00000XCase Manager/Care Coordinator

General Provider Information

NPI Number : 1467903351
Entity Type Code : Individual
Provider Name (Legal Business Name) : LORI HEAVLIN
Provider Business Mailing Address
First Line : 310 PENNSYLVANIA AVE
Second Line :
City : ELMIRA
State : NY
Zip : 14904-1458
Country : US
Telephone Number : 607-733-2820
Fax Number : 607-733-0402
Provider Business Practice Location Address
First Line : 310 PENNSYLVANIA AVE
Second Line :
City : ELMIRA
State : NY
Zip : 14904-1458
Country : US
Telephone Number : 607-733-2820
Fax Number : 607-733-0402
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/17/2016
Last Update Date : 10/17/2016

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Directions to “ LORI HEAVLIN ” Practice Location

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