Provider Demographics
NPI:1083249353
Name:KORTKAMP, LORI (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:LORI
Middle Name:
Last Name:KORTKAMP
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6762 WARNER AVE APT M2
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92647-5324
Mailing Address - Country:US
Mailing Address - Phone:562-253-3122
Mailing Address - Fax:
Practice Address - Street 1:6762 WARNER AVE APT M2
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92647-5324
Practice Address - Country:US
Practice Address - Phone:562-253-3122
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-07
Last Update Date:2021-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95013689363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily