Provider Demographics
NPI:1679235162
Name:ELDEMIRE, LORI-ANN
Entity Type:Individual
Prefix:
First Name:LORI-ANN
Middle Name:
Last Name:ELDEMIRE
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 1:4216 OAKNOLL CIR
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30096-5543
Mailing Address - Country:US
Mailing Address - Phone:772-877-9084
Mailing Address - Fax:
Practice Address - Street 1:4216 OAKNOLL CIR
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096-5543
Practice Address - Country:US
Practice Address - Phone:772-877-9084
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-12
Last Update Date:2021-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health