Provider Demographics
NPI:1407296536
Name:LORE, CHAD D (CNP)
Entity Type:Individual
Prefix:
First Name:CHAD
Middle Name:D
Last Name:LORE
Suffix:
Gender:M
Credentials:CNP
Other - Prefix:
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Mailing Address - Street 1:1735 27TH ST STE B06
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:OH
Mailing Address - Zip Code:45662-2681
Mailing Address - Country:US
Mailing Address - Phone:740-356-8034
Mailing Address - Fax:740-353-7900
Practice Address - Street 1:1121 KINNEYS LN
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:OH
Practice Address - Zip Code:45662-2806
Practice Address - Country:US
Practice Address - Phone:740-356-7490
Practice Address - Fax:740-356-7488
Is Sole Proprietor?:No
Enumeration Date:2013-07-03
Last Update Date:2020-12-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.14693363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner