Provider Demographics
NPI:1114263506
Name:LINK, LORI ELIZABETH (CNM, MSN)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:ELIZABETH
Last Name:LINK
Suffix:
Gender:F
Credentials:CNM, MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1984
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:CA
Mailing Address - Zip Code:95971-1984
Mailing Address - Country:US
Mailing Address - Phone:417-838-8860
Mailing Address - Fax:
Practice Address - Street 1:1065 BUCKS LAKE RD
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:CA
Practice Address - Zip Code:95971-9599
Practice Address - Country:US
Practice Address - Phone:530-283-7969
Practice Address - Fax:530-283-7967
Is Sole Proprietor?:No
Enumeration Date:2012-12-12
Last Update Date:2022-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO144282367A00000X
CA236280367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife