Provider Demographics
NPI:1578939450
Name:DEWITT, LORI (RN, BSN, CPN)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:
Last Name:DEWITT
Suffix:
Gender:F
Credentials:RN, BSN, CPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:206 LAKE ST
Mailing Address - Street 2:
Mailing Address - City:PARKIN
Mailing Address - State:AR
Mailing Address - Zip Code:72373
Mailing Address - Country:US
Mailing Address - Phone:870-755-2737
Mailing Address - Fax:870-755-2740
Practice Address - Street 1:206 LAKE
Practice Address - Street 2:
Practice Address - City:PARKIN
Practice Address - State:AR
Practice Address - Zip Code:72373
Practice Address - Country:US
Practice Address - Phone:870-755-2737
Practice Address - Fax:870-755-2740
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-14
Last Update Date:2015-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR074282163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse