Provider Demographics
NPI:1144619644
Name:DUSAN, LORI
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:
Last Name:DUSAN
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 1:710 MARION ST SW
Mailing Address - Street 2:
Mailing Address - City:ISANTI
Mailing Address - State:MN
Mailing Address - Zip Code:55040-7251
Mailing Address - Country:US
Mailing Address - Phone:763-913-8363
Mailing Address - Fax:
Practice Address - Street 1:710 MARION ST SW
Practice Address - Street 2:
Practice Address - City:ISANTI
Practice Address - State:MN
Practice Address - Zip Code:55040-7251
Practice Address - Country:US
Practice Address - Phone:763-913-8363
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-21
Last Update Date:2015-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health