Provider Demographics
NPI:1275786048
Name:VANDENBUSCHE, LORIE MARIE (RN, CNP)
Entity Type:Individual
Prefix:
First Name:LORIE
Middle Name:MARIE
Last Name:VANDENBUSCHE
Suffix:
Gender:F
Credentials:RN, CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3780 MEDINA RD STE 105
Mailing Address - Street 2:
Mailing Address - City:MEDINA
Mailing Address - State:OH
Mailing Address - Zip Code:44256-9311
Mailing Address - Country:US
Mailing Address - Phone:330-722-2341
Mailing Address - Fax:
Practice Address - Street 1:3780 MEDINA RD STE 105
Practice Address - Street 2:
Practice Address - City:MEDINA
Practice Address - State:OH
Practice Address - Zip Code:44256-9311
Practice Address - Country:US
Practice Address - Phone:330-722-2341
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-24
Last Update Date:2012-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA.10232-NP363L00000X
OHCOA10232-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner