Provider Demographics
NPI:1568476349
Name:LAFAYETTE, LORI (PA-C)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:
Last Name:LAFAYETTE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 MULBERRY ST STE A
Mailing Address - Street 2:
Mailing Address - City:WAPELLO
Mailing Address - State:IA
Mailing Address - Zip Code:52653-1570
Mailing Address - Country:US
Mailing Address - Phone:319-768-4090
Mailing Address - Fax:
Practice Address - Street 1:220 MULBERRY ST STE A
Practice Address - Street 2:
Practice Address - City:WAPELLO
Practice Address - State:IA
Practice Address - Zip Code:52653-1570
Practice Address - Country:US
Practice Address - Phone:319-768-4090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2016-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA233233OtherMIDLANDS CHOICE
IA40889OtherWELLMARK BLUE CROSS BLUE
IA163849OtherRH MEDICARE
IA40889OtherWELLMARK BLUE CROSS BLUE
IA97003065Medicare PIN
IAS43818Medicare UPIN