Provider Demographics
NPI:1326399882
Name:FIJALKOWSKI, LORI ANN
Entity Type:Individual
Prefix:MRS
First Name:LORI
Middle Name:ANN
Last Name:FIJALKOWSKI
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:LORI
Other - Middle Name:ANN
Other - Last Name:FIJALKOWSKI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPN
Mailing Address - Street 1:305 S CHESTER AVE
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:NJ
Mailing Address - Zip Code:08075-4018
Mailing Address - Country:US
Mailing Address - Phone:609-534-6073
Mailing Address - Fax:
Practice Address - Street 1:305 S CHESTER AVE
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:NJ
Practice Address - Zip Code:08075-4018
Practice Address - Country:US
Practice Address - Phone:609-534-6073
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-25
Last Update Date:2012-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NP0663600164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse