Provider Demographics
NPI:1710758107
Name:LUM, LORRINE CHI (RN)
Entity Type:Individual
Prefix:
First Name:LORRINE
Middle Name:CHI
Last Name:LUM
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 FRONT ST APT B
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05401-5614
Mailing Address - Country:US
Mailing Address - Phone:678-943-7638
Mailing Address - Fax:
Practice Address - Street 1:28 FRONT ST APT B
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05401-5614
Practice Address - Country:US
Practice Address - Phone:678-943-7638
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-15
Last Update Date:2024-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY886121163WN0300X
MDR253181163WC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine
No163WN0300XNursing Service ProvidersRegistered NurseNephrology