Provider Demographics
NPI:1659789196
Name:CORK, LORA LEE (RN, MSN, FNP-BC)
Entity Type:Individual
Prefix:
First Name:LORA
Middle Name:LEE
Last Name:CORK
Suffix:
Gender:F
Credentials:RN, MSN, FNP-BC
Other - Prefix:
Other - First Name:LORA
Other - Middle Name:LEE
Other - Last Name:STRUVE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN, BSN
Mailing Address - Street 1:20392 ALISTON LN
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:WA
Mailing Address - Zip Code:98233-3540
Mailing Address - Country:US
Mailing Address - Phone:360-708-4676
Mailing Address - Fax:
Practice Address - Street 1:505 S 336TH ST
Practice Address - Street 2:SUITE 600
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-5947
Practice Address - Country:US
Practice Address - Phone:253-838-6180
Practice Address - Fax:253-838-6418
Is Sole Proprietor?:No
Enumeration Date:2014-07-29
Last Update Date:2014-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60476508363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner