Provider Demographics
NPI:1417573304
Name:CRISS, LORI
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:
Last Name:CRISS
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 1:1005 TERMINAL WAY STE 125
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89502-2198
Mailing Address - Country:US
Mailing Address - Phone:877-786-4999
Mailing Address - Fax:
Practice Address - Street 1:565 W TULE ST
Practice Address - Street 2:
Practice Address - City:BATTLE MTN
Practice Address - State:NV
Practice Address - Zip Code:89820-1842
Practice Address - Country:US
Practice Address - Phone:775-635-2686
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-17
Last Update Date:2020-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant