Provider Demographics
NPI:1477766822
Name:DESHANE, LORI ANN (RN)
Entity Type:Individual
Prefix:MRS
First Name:LORI
Middle Name:ANN
Last Name:DESHANE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MS
Other - First Name:LORI
Other - Middle Name:ANN
Other - Last Name:RYDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:1029 WESTERN AVE # 2
Mailing Address - Street 2:
Mailing Address - City:HAMPDEN
Mailing Address - State:ME
Mailing Address - Zip Code:04444-3312
Mailing Address - Country:US
Mailing Address - Phone:207-990-9000
Mailing Address - Fax:207-945-8645
Practice Address - Street 1:1 CUMBERLAND PL
Practice Address - Street 2:SUITE 108
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-5083
Practice Address - Country:US
Practice Address - Phone:207-990-9000
Practice Address - Fax:207-945-8645
Is Sole Proprietor?:No
Enumeration Date:2007-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MER051345163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health