Provider Demographics
NPI:1174648299
Name:JACQUES, LORI B (RN, CCM)
Entity Type:Individual
Prefix:MS
First Name:LORI
Middle Name:B
Last Name:JACQUES
Suffix:
Gender:F
Credentials:RN, CCM
Other - Prefix:MS
Other - First Name:LORI
Other - Middle Name:A
Other - Last Name:BELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:CAMPUS AVENUE, PO BOX 291
Mailing Address - Street 2:CASE MANAGEMENT DEPARTMENT
Mailing Address - City:LEWISTON
Mailing Address - State:ME
Mailing Address - Zip Code:04243-0291
Mailing Address - Country:US
Mailing Address - Phone:207-777-8507
Mailing Address - Fax:207-753-5488
Practice Address - Street 1:93 CAMPUS AVENUE
Practice Address - Street 2:CASE MANAGEMENT DEPARTMENT
Practice Address - City:LEWISTON
Practice Address - State:ME
Practice Address - Zip Code:04240
Practice Address - Country:US
Practice Address - Phone:207-777-8507
Practice Address - Fax:207-753-5488
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MER027612163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management