Provider Demographics
NPI:1497041057
Name:CANTWELL, LORRETTA LYNNE (RN)
Entity Type:Individual
Prefix:MRS
First Name:LORRETTA
Middle Name:LYNNE
Last Name:CANTWELL
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MRS
Other - First Name:LORRETTA
Other - Middle Name:LYNNE
Other - Last Name:NOLAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:511 LANGERS LN
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97402-2203
Mailing Address - Country:US
Mailing Address - Phone:541-912-2975
Mailing Address - Fax:
Practice Address - Street 1:2073 OLYMPIC ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OR
Practice Address - Zip Code:97477-3413
Practice Address - Country:US
Practice Address - Phone:541-682-3550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-22
Last Update Date:2012-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR200540024RN163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health