Provider Demographics
NPI:1407461155
Name:IRELAND, LORI ANNE
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:ANNE
Last Name:IRELAND
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:244 PRESIDENT ST
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29403-4798
Mailing Address - Country:US
Mailing Address - Phone:843-579-4820
Mailing Address - Fax:843-579-4830
Practice Address - Street 1:244 PRESIDENT ST
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29403-4798
Practice Address - Country:US
Practice Address - Phone:846-579-4820
Practice Address - Fax:843-579-4830
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-10
Last Update Date:2020-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC204277163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool