Provider Demographics
NPI:1598837536
Name:MCINTOSH, LORRI JO (RNC)
Entity Type:Individual
Prefix:MS
First Name:LORRI
Middle Name:JO
Last Name:MCINTOSH
Suffix:
Gender:F
Credentials:RNC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:141 MOSS LN
Mailing Address - Street 2:
Mailing Address - City:GRANTS PASS
Mailing Address - State:OR
Mailing Address - Zip Code:97527-9044
Mailing Address - Country:US
Mailing Address - Phone:541-471-2978
Mailing Address - Fax:541-471-2978
Practice Address - Street 1:141 MOSS LN
Practice Address - Street 2:
Practice Address - City:GRANTS PASS
Practice Address - State:OR
Practice Address - Zip Code:97527-9044
Practice Address - Country:US
Practice Address - Phone:541-471-2978
Practice Address - Fax:541-471-2978
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse