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NPI Code Detail

MEDICARE: LORI CARMEN CRNA

MEDICARE: LORI CARMEN CRNA
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
1367500000XCertified Registered Nurse AnesthetistR47417NM

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1430074229OTHERNMRAILROAD MEDICARE INDIVID

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2NM006426OTHERNMBCB NM - INDIVIDUAL
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1740275924
Entity Type Code : Individual
Provider Name (Legal Business Name) : LORI CARMEN CRNA
Provider Business Mailing Address
First Line : 1000 CORDOVA PL
Second Line : # 712
City : SANTA FE
State : NM
Zip : 87505-1725
Country : US
Telephone Number : 505-747-8639
Fax Number :
Provider Business Practice Location Address
First Line : 1010 SPRUCE ST
Second Line :
City : ESPANOLA
State : NM
Zip : 87532-3456
Country : US
Telephone Number : 505-753-7111
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/14/2005
Last Update Date : 02/05/2019

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Directions to “ LORI CARMEN CRNA” Practice Location

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