Provider Demographics
NPI:1003893108
Name:NILAND, LORI A (PA-C)
Entity Type:Individual
Prefix:MS
First Name:LORI
Middle Name:A
Last Name:NILAND
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:LORI
Other - Middle Name:A
Other - Last Name:DOREN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PAC-C
Mailing Address - Street 1:PO BOX 16023
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ME
Mailing Address - Zip Code:04243-9503
Mailing Address - Country:US
Mailing Address - Phone:207-396-8600
Mailing Address - Fax:603-692-6040
Practice Address - Street 1:22 BRAMHALL STREET
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04102
Practice Address - Country:US
Practice Address - Phone:207-662-2934
Practice Address - Fax:207-662-6389
Is Sole Proprietor?:No
Enumeration Date:2005-12-29
Last Update Date:2015-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPA-620363A00000X
NH0859363A00000X
MEPA620363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3071700Medicaid
NHP01038297OtherRAILROAD MEDICARE
NH30332527Medicaid
NHP01038297OtherRAILROAD MEDICARE