Provider Demographics
NPI:1326673575
Name:MIKNAITIS, LORI (APRN, FNP-C)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:
Last Name:MIKNAITIS
Suffix:
Gender:F
Credentials:APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:650 CASTINE POINT DR
Mailing Address - Street 2:
Mailing Address - City:MANDEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70448-4402
Mailing Address - Country:US
Mailing Address - Phone:504-234-2385
Mailing Address - Fax:
Practice Address - Street 1:19065 DR JOHN LAMBERT DR
Practice Address - Street 2:
Practice Address - City:HAMMOND
Practice Address - State:LA
Practice Address - Zip Code:70403-0996
Practice Address - Country:US
Practice Address - Phone:985-222-5577
Practice Address - Fax:985-222-3532
Is Sole Proprietor?:No
Enumeration Date:2020-03-09
Last Update Date:2020-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA204297363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner