Provider Demographics
NPI:1215187588
Name:MASSEY, LORINA KAY (APRN)
Entity Type:Individual
Prefix:
First Name:LORINA
Middle Name:KAY
Last Name:MASSEY
Suffix:
Gender:F
Credentials:APRN
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 262
Mailing Address - Street 2:
Mailing Address - City:LIBERTY LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:99019-0012
Mailing Address - Country:US
Mailing Address - Phone:866-747-2455
Mailing Address - Fax:
Practice Address - Street 1:6 13TH AVE E
Practice Address - Street 2:
Practice Address - City:POLSON
Practice Address - State:MT
Practice Address - Zip Code:59860-5315
Practice Address - Country:US
Practice Address - Phone:406-883-5680
Practice Address - Fax:406-883-8910
Is Sole Proprietor?:No
Enumeration Date:2008-09-24
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT100457363LF0000X
MTNUR-APRN-LIC-100457363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
000901963OtherBLUE CROSS OF MONTANA
MT271323Medicare Oscar/Certification
000901963OtherBLUE CROSS OF MONTANA
MT273979Medicare Oscar/Certification
MT273999Medicare Oscar/Certification
MT273980Medicare Oscar/Certification
MT273997Medicare Oscar/Certification