Provider Demographics
NPI:1588217400
Name:PRITT, LORELLA L (LPN)
Entity Type:Individual
Prefix:
First Name:LORELLA
Middle Name:L
Last Name:PRITT
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:LORI
Other - Middle Name:
Other - Last Name:PRITT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPN
Mailing Address - Street 1:708 SOUTHSIDE ST
Mailing Address - Street 2:
Mailing Address - City:VALLEY SPRINGS
Mailing Address - State:SD
Mailing Address - Zip Code:57068-9354
Mailing Address - Country:US
Mailing Address - Phone:605-757-6155
Mailing Address - Fax:
Practice Address - Street 1:708 SOUTHSIDE ST
Practice Address - Street 2:
Practice Address - City:VALLEY SPRINGS
Practice Address - State:SD
Practice Address - Zip Code:57068-9354
Practice Address - Country:US
Practice Address - Phone:605-757-6155
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-19
Last Update Date:2019-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDP013001164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse