Provider Demographics
NPI:1407288863
Name:MALLORY, LORI RENEE (APRN)
Entity Type:Individual
Prefix:MRS
First Name:LORI
Middle Name:RENEE
Last Name:MALLORY
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:201 CAPITOL BEACH BLVD STE 1A
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68528-1645
Mailing Address - Country:US
Mailing Address - Phone:402-435-0228
Mailing Address - Fax:402-435-0229
Practice Address - Street 1:201 CAPITOL BEACH BLVD STE 1A
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68528-1645
Practice Address - Country:US
Practice Address - Phone:402-435-0228
Practice Address - Fax:402-435-0229
Is Sole Proprietor?:No
Enumeration Date:2013-08-07
Last Update Date:2013-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1911363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily