Provider Demographics
NPI:1073675153
Name:MORRILL, LORI KAY (PA)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:KAY
Last Name:MORRILL
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:908 NIAGARA FALLS BLVD STE 208
Mailing Address - Street 2:
Mailing Address - City:NORTH TONAWANDA
Mailing Address - State:NY
Mailing Address - Zip Code:14120-2019
Mailing Address - Country:US
Mailing Address - Phone:716-692-3302
Mailing Address - Fax:716-692-4342
Practice Address - Street 1:623 MAIN ST STE 200
Practice Address - Street 2:
Practice Address - City:OLEAN
Practice Address - State:NY
Practice Address - Zip Code:14760-1532
Practice Address - Country:US
Practice Address - Phone:716-701-1818
Practice Address - Fax:716-701-1820
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2020-01-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY024476363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP39984Medicare UPIN