Provider Demographics
NPI:1629268909
Name:CHRISTIANO, LORI
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:
Last Name:CHRISTIANO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3040 AMSDELL RD
Mailing Address - Street 2:ATTN: CREDENTIALING
Mailing Address - City:HAMBURG
Mailing Address - State:NY
Mailing Address - Zip Code:14075-5835
Mailing Address - Country:US
Mailing Address - Phone:716-646-6700
Mailing Address - Fax:716-646-8515
Practice Address - Street 1:3040 AMSDELL RD
Practice Address - Street 2:ATTN: CREDENTIALING
Practice Address - City:HAMBURG
Practice Address - State:NY
Practice Address - Zip Code:14075-5835
Practice Address - Country:US
Practice Address - Phone:716-646-6700
Practice Address - Fax:716-646-8515
Is Sole Proprietor?:No
Enumeration Date:2007-08-01
Last Update Date:2012-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF335319363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily