Provider Demographics
NPI:1235485731
Name:BIRD, LORA C (ANP-C)
Entity Type:Individual
Prefix:
First Name:LORA
Middle Name:C
Last Name:BIRD
Suffix:
Gender:F
Credentials:ANP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5990 WILLOWBEND ST
Mailing Address - Street 2:
Mailing Address - City:WEST RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99353-6079
Mailing Address - Country:US
Mailing Address - Phone:814-753-0687
Mailing Address - Fax:
Practice Address - Street 1:705 GAGE BLVD STE 102
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99352-9716
Practice Address - Country:US
Practice Address - Phone:814-753-0687
Practice Address - Fax:509-942-3273
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-02
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN18180363LA2200X
WAAP60519194363LA2200X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT96187OtherRN LICENSE
OR202005260NP-PPOtherOREGON BOARD OF NURSING
WA1235485731Medicaid
TN18180OtherTN BOARD OF NURSING