Provider Demographics
NPI:1114934684
Name:PETERS, LORI KAY (CRNP)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:KAY
Last Name:PETERS
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 WESTERN MARYLAND PKWY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21740-5471
Mailing Address - Country:US
Mailing Address - Phone:301-797-6389
Mailing Address - Fax:301-797-4119
Practice Address - Street 1:85 THOMAS JOHNSON CT
Practice Address - Street 2:SUITE D
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21702-4331
Practice Address - Country:US
Practice Address - Phone:301-797-6389
Practice Address - Fax:301-797-4119
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2014-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR127498363L00000X
PARN655903163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
P01278432OtherRR MEDICARE
MDW2660035OtherBLUE SHIELD
MD072020800Medicaid
MD327703YQUMedicare PIN