Provider Demographics
NPI:1518368125
Name:LIN, LORI MARIE (RN)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:MARIE
Last Name:LIN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:LORI
Other - Middle Name:MARIE
Other - Last Name:AMERAULT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:2118 SAINT MARY DR
Mailing Address - Street 2:
Mailing Address - City:CAMP LEJEUNE
Mailing Address - State:NC
Mailing Address - Zip Code:28547-1312
Mailing Address - Country:US
Mailing Address - Phone:774-259-0400
Mailing Address - Fax:
Practice Address - Street 1:2118 SAINT MARY DR
Practice Address - Street 2:
Practice Address - City:CAMP LEJEUNE
Practice Address - State:NC
Practice Address - Zip Code:28547-1312
Practice Address - Country:US
Practice Address - Phone:774-259-0400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-15
Last Update Date:2014-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC271070163W00000X
MARN264419163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse