Provider Demographics
NPI:1629182258
Name:PEYSHA, LORI ELIZABETH (CNP)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:ELIZABETH
Last Name:PEYSHA
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:LORI
Other - Middle Name:ELIZABETH
Other - Last Name:DRAGMEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNP
Mailing Address - Street 1:PO BOX 8792
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-8792
Mailing Address - Country:US
Mailing Address - Phone:216-382-9935
Mailing Address - Fax:216-297-0377
Practice Address - Street 1:1611 S GREEN RD STE 160
Practice Address - Street 2:
Practice Address - City:SOUTH EUCLID
Practice Address - State:OH
Practice Address - Zip Code:44121-6100
Practice Address - Country:US
Practice Address - Phone:216-382-9935
Practice Address - Fax:216-297-0377
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2011-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN234958163WD0400X
OH05012-NP363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2833198Medicaid
OHNP22321Medicare PIN