Provider Demographics
NPI:1598739088
Name:MAURER, LORI LYNNE (LPN)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:LYNNE
Last Name:MAURER
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10829 EL PASO DR
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:33569-7330
Mailing Address - Country:US
Mailing Address - Phone:440-789-9853
Mailing Address - Fax:
Practice Address - Street 1:10829 EL PASO DR
Practice Address - Street 2:
Practice Address - City:RIVERVIEW
Practice Address - State:FL
Practice Address - Zip Code:33569-7330
Practice Address - Country:US
Practice Address - Phone:440-789-9853
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-14
Last Update Date:2016-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN 073711164W00000X
FLPN5221408164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2212153Medicaid