Provider Demographics
NPI:1427185123
Name:GITTINGS, LORI
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:
Last Name:GITTINGS
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 1:405 OAK DR
Mailing Address - Street 2:
Mailing Address - City:LAMAR
Mailing Address - State:CO
Mailing Address - Zip Code:81052-2938
Mailing Address - Country:US
Mailing Address - Phone:719-336-8721
Mailing Address - Fax:
Practice Address - Street 1:1001 S OUTH MAIN
Practice Address - Street 2:
Practice Address - City:LAMAR
Practice Address - State:CO
Practice Address - Zip Code:81052
Practice Address - Country:US
Practice Address - Phone:719-336-8721
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO124342163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO35251531Medicaid