Provider Demographics
NPI:1497470132
Name:INGLES, LORI
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:
Last Name:INGLES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DOLORES
Other - Middle Name:DIANNE, MAGNUS
Other - Last Name:MAGNUS, BERRY, SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:151 CAPITOL ST STE 4
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:ME
Mailing Address - Zip Code:04330-6262
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:151 CAPITOL ST STE 4
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:ME
Practice Address - Zip Code:04330-6262
Practice Address - Country:US
Practice Address - Phone:207-512-8549
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-05
Last Update Date:2022-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MERN37830163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse