Provider Demographics
NPI:1326694282
Name:LORSHBOUGH, GLEN
Entity Type:Individual
Prefix:
First Name:GLEN
Middle Name:
Last Name:LORSHBOUGH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16047 GRANGE RD NW
Mailing Address - Street 2:
Mailing Address - City:SHEVLIN
Mailing Address - State:MN
Mailing Address - Zip Code:56676-4510
Mailing Address - Country:US
Mailing Address - Phone:218-766-7563
Mailing Address - Fax:218-243-2724
Practice Address - Street 1:16047 GRANGE RD NW
Practice Address - Street 2:
Practice Address - City:SHEVLIN
Practice Address - State:MN
Practice Address - Zip Code:56676-4510
Practice Address - Country:US
Practice Address - Phone:218-766-7563
Practice Address - Fax:218-243-2724
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-15
Last Update Date:2019-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies