Provider Demographics
NPI:1447587043
Name:HEARTY, LORI LYNN
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:LYNN
Last Name:HEARTY
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 1:5158 W LAKE PL
Mailing Address - Street 2:5158 W LAKE PLACE
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80123-6726
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5158 W LAKE PL
Practice Address - Street 2:5158 W LAKE PLACE
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80123-6726
Practice Address - Country:US
Practice Address - Phone:303-554-0251
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-03
Last Update Date:2009-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO102672163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse