Provider Demographics
NPI:1164127452
Name:SHINE, LORI ANN
Entity Type:Individual
Prefix:MRS
First Name:LORI
Middle Name:ANN
Last Name:SHINE
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 1:6262 STATE ROUTE 322
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44093-9749
Mailing Address - Country:US
Mailing Address - Phone:440-536-1628
Mailing Address - Fax:
Practice Address - Street 1:6262 STATE ROUTE 322
Practice Address - Street 2:
Practice Address - City:WILLIAMSFIELD
Practice Address - State:OH
Practice Address - Zip Code:44093-9749
Practice Address - Country:US
Practice Address - Phone:440-536-1628
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-04
Last Update Date:2023-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH401594471213376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide