Provider Demographics
NPI:1437805942
Name:GLOVER, LORI LYNETTE (NP)
Entity Type:Individual
Prefix:MRS
First Name:LORI
Middle Name:LYNETTE
Last Name:GLOVER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:137 CAMDEN DR
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:GA
Mailing Address - Zip Code:31523-7814
Mailing Address - Country:US
Mailing Address - Phone:912-602-0676
Mailing Address - Fax:
Practice Address - Street 1:137 CAMDEN DR
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:GA
Practice Address - Zip Code:31523-7814
Practice Address - Country:US
Practice Address - Phone:912-602-0676
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-23
Last Update Date:2022-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN172006363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care