Provider Demographics
NPI:1497984223
Name:HANCOCK, LORRAINE ANN WEST (RN, CMT, CIMI (R), C)
Entity Type:Individual
Prefix:MRS
First Name:LORRAINE
Middle Name:ANN WEST
Last Name:HANCOCK
Suffix:
Gender:F
Credentials:RN, CMT, CIMI (R), C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
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Mailing Address - Street 1:6657 OLD BLACKSMITH DRIVE
Mailing Address - Street 2:
Mailing Address - City:BURKE
Mailing Address - State:VA
Mailing Address - Zip Code:22015-4139
Mailing Address - Country:US
Mailing Address - Phone:703-909-0299
Mailing Address - Fax:703-451-9043
Practice Address - Street 1:5417C BACKLICK ROAD
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:VA
Practice Address - Zip Code:22151-3915
Practice Address - Country:US
Practice Address - Phone:703-909-0299
Practice Address - Fax:703-451-9043
Is Sole Proprietor?:No
Enumeration Date:2009-07-14
Last Update Date:2009-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VARN#0001068875163W00000X
VA#0001900232174400000X
WA#000538174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No174400000XOther Service ProvidersSpecialist