Provider Demographics
NPI:1053829846
Name:HARSHMAN, LORI MARIE
Entity Type:Individual
Prefix:MS
First Name:LORI
Middle Name:MARIE
Last Name:HARSHMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35885 LODGE RD
Mailing Address - Street 2:
Mailing Address - City:TOLLHOUSE
Mailing Address - State:CA
Mailing Address - Zip Code:93667-9624
Mailing Address - Country:US
Mailing Address - Phone:559-269-1871
Mailing Address - Fax:
Practice Address - Street 1:35885 LODGE RD
Practice Address - Street 2:
Practice Address - City:TOLLHOUSE
Practice Address - State:CA
Practice Address - Zip Code:93667-9624
Practice Address - Country:US
Practice Address - Phone:559-269-1871
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-16
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA418464363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA418464OtherBRN