Provider Demographics
NPI:1336491430
Name:METTETAL, LORIJEAN MARJORIE (FNP-C)
Entity Type:Individual
Prefix:MS
First Name:LORIJEAN
Middle Name:MARJORIE
Last Name:METTETAL
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 BUFFALO ST
Mailing Address - Street 2:LAKESHORE COMMUNITY HEALTH CENTER
Mailing Address - City:MANITOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:54220-6817
Mailing Address - Country:US
Mailing Address - Phone:423-483-2192
Mailing Address - Fax:
Practice Address - Street 1:601 BUFFALO ST
Practice Address - Street 2:LAKESHORE COMMUNITY HEALTH CLINIC
Practice Address - City:MANITOWOC
Practice Address - State:WI
Practice Address - Zip Code:54220-6817
Practice Address - Country:US
Practice Address - Phone:423-975-2200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-12
Last Update Date:2016-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6919-33363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner