Provider Demographics
NPI:1316180003
Name:BEAVER, LORI C (RRT, RCP)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:C
Last Name:BEAVER
Suffix:
Gender:F
Credentials:RRT, RCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1041
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSTON
Mailing Address - State:NC
Mailing Address - Zip Code:27892-1041
Mailing Address - Country:US
Mailing Address - Phone:252-792-1659
Mailing Address - Fax:252-792-2043
Practice Address - Street 1:115 E MAIN ST STE 18
Practice Address - Street 2:
Practice Address - City:WILLIAMSTON
Practice Address - State:NC
Practice Address - Zip Code:27892-2482
Practice Address - Country:US
Practice Address - Phone:252-792-1659
Practice Address - Fax:252-792-2043
Is Sole Proprietor?:No
Enumeration Date:2009-04-11
Last Update Date:2009-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1436227900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes227900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7492755Medicaid