Provider Demographics
NPI:1275861767
Name:TORDSEN, LORI ELAINE (LVN)
Entity Type:Individual
Prefix:MRS
First Name:LORI
Middle Name:ELAINE
Last Name:TORDSEN
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:471 CASTLE DR
Mailing Address - Street 2:
Mailing Address - City:PARADISE
Mailing Address - State:CA
Mailing Address - Zip Code:95969-3051
Mailing Address - Country:US
Mailing Address - Phone:530-327-7665
Mailing Address - Fax:
Practice Address - Street 1:471 CASTLE DR
Practice Address - Street 2:
Practice Address - City:PARADISE
Practice Address - State:CA
Practice Address - Zip Code:95969-3051
Practice Address - Country:US
Practice Address - Phone:530-327-7665
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-23
Last Update Date:2009-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN 162073164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse