Provider Demographics
NPI:1275522302
Name:FORTIER, LORI (CNM, WHNP)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:
Last Name:FORTIER
Suffix:
Gender:F
Credentials:CNM, WHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1836 EUCLID AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44115-2235
Mailing Address - Country:US
Mailing Address - Phone:216-687-3649
Mailing Address - Fax:216-687-9319
Practice Address - Street 1:1836 EUCLID AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44115-2235
Practice Address - Country:US
Practice Address - Phone:216-687-3649
Practice Address - Fax:216-687-9319
Is Sole Proprietor?:No
Enumeration Date:2005-10-20
Last Update Date:2013-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH252426363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health