Provider Demographics
NPI:1710030929
Name:GERHARDT, LORI CANNON (RN ANP)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:CANNON
Last Name:GERHARDT
Suffix:
Gender:F
Credentials:RN ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1002 N CHURCH ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27401-1439
Mailing Address - Country:US
Mailing Address - Phone:336-272-6133
Mailing Address - Fax:
Practice Address - Street 1:1126 N CHURCH ST STE 300
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27401-1037
Practice Address - Country:US
Practice Address - Phone:336-938-0800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-19
Last Update Date:2021-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC900124363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
2595166Medicare ID - Type Unspecified
S51501Medicare UPIN