Provider Demographics
NPI:1548587116
Name:REITER, LORI ELLEN (RN)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:ELLEN
Last Name:REITER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:LORI
Other - Middle Name:ELLEN
Other - Last Name:NICHOLS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:2321 REEVES AVE
Mailing Address - Street 2:
Mailing Address - City:LEWIS CENTER
Mailing Address - State:OH
Mailing Address - Zip Code:43035-9682
Mailing Address - Country:US
Mailing Address - Phone:740-879-3717
Mailing Address - Fax:
Practice Address - Street 1:2760 AIRPORT DR STE 130
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43219-2294
Practice Address - Country:US
Practice Address - Phone:800-616-3718
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-22
Last Update Date:2012-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN 201460163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse