Provider Demographics
NPI:1255850970
Name:VLAZNY, LORI RAE (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:LORI
Middle Name:RAE
Last Name:VLAZNY
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19866 200TH ST
Mailing Address - Street 2:
Mailing Address - City:FARMERSBURG
Mailing Address - State:IA
Mailing Address - Zip Code:52047-8066
Mailing Address - Country:US
Mailing Address - Phone:563-783-2434
Mailing Address - Fax:
Practice Address - Street 1:101 FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:MONONA
Practice Address - State:IA
Practice Address - Zip Code:52159-8092
Practice Address - Country:US
Practice Address - Phone:563-539-5656
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-13
Last Update Date:2017-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA075048363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily