Provider Demographics
NPI:1407840721
Name:HOCKENBERRY, LORI L (CRNA)
Entity Type:Individual
Prefix:MS
First Name:LORI
Middle Name:L
Last Name:HOCKENBERRY
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 W HIGH ST
Mailing Address - Street 2:5TH FLOOR
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45801-4340
Mailing Address - Country:US
Mailing Address - Phone:419-998-4573
Mailing Address - Fax:419-998-4586
Practice Address - Street 1:5734 COVENTRY LANE
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46804-7141
Practice Address - Country:US
Practice Address - Phone:260-436-7875
Practice Address - Fax:260-432-9812
Is Sole Proprietor?:No
Enumeration Date:2005-09-01
Last Update Date:2016-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN226280367500000X
IN28100297367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000209221OtherANTHEM BC/BS
OH34195975700OtherWORKMENS COMPENSATION
OH3419597570004OtherMEDICAL MUTUAL OF OHIO
OH2191686Medicaid
OH430065384OtherMEDICARE RAILROAD
OH430065384OtherMEDICARE RAILROAD
OHH062201Medicare PIN