Provider Demographics
NPI:1376674747
Name:FORTUNATI, LORRAINE F (CRNP)
Entity Type:Individual
Prefix:MS
First Name:LORRAINE
Middle Name:F
Last Name:FORTUNATI
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4305 W SAMARA CT
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83703-4048
Mailing Address - Country:US
Mailing Address - Phone:208-344-7757
Mailing Address - Fax:
Practice Address - Street 1:707 N ARMSTRONG PL
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-0825
Practice Address - Country:US
Practice Address - Phone:208-327-8623
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDNP222A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily