Provider Demographics
NPI:1467570663
Name:SHOCKLEY, LORIE MARIE (LPN)
Entity Type:Individual
Prefix:MS
First Name:LORIE
Middle Name:MARIE
Last Name:SHOCKLEY
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:341 N HIGH ST
Mailing Address - Street 2:P.O. BOX 27
Mailing Address - City:CALEDONIA
Mailing Address - State:OH
Mailing Address - Zip Code:43314-7718
Mailing Address - Country:US
Mailing Address - Phone:740-362-1470
Mailing Address - Fax:
Practice Address - Street 1:341 N HIGH ST
Practice Address - Street 2:
Practice Address - City:CALEDONIA
Practice Address - State:OH
Practice Address - Zip Code:43314-7718
Practice Address - Country:US
Practice Address - Phone:740-362-1470
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2016-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN122469164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2665414Medicaid