Provider Demographics
NPI:1326157678
Name:DIRAFFAELLO, LORRAINE NANETTE (CRNA)
Entity Type:Individual
Prefix:
First Name:LORRAINE
Middle Name:NANETTE
Last Name:DIRAFFAELLO
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:LORRAINE
Other - Middle Name:NANETTE
Other - Last Name:RAFAELO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:5665 NEW NORTHSIDE DR
Mailing Address - Street 2:SUITE 320
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30328-5831
Mailing Address - Country:US
Mailing Address - Phone:770-874-5454
Mailing Address - Fax:
Practice Address - Street 1:825 DELBON AVE
Practice Address - Street 2:
Practice Address - City:TURLOCK
Practice Address - State:CA
Practice Address - Zip Code:95382-2016
Practice Address - Country:US
Practice Address - Phone:209-667-4200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2015-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30004365367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
S41628Medicare UPIN
8856712Medicare ID - Type Unspecified
WA9640657Medicaid