Provider Demographics
NPI:1720018377
Name:KAISER, LORRAINE R (APRN, BC)
Entity Type:Individual
Prefix:
First Name:LORRAINE
Middle Name:R
Last Name:KAISER
Suffix:
Gender:F
Credentials:APRN, BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:176 OLD COUNTY RD
Mailing Address - Street 2:
Mailing Address - City:WESTPORT
Mailing Address - State:MA
Mailing Address - Zip Code:02790-1172
Mailing Address - Country:US
Mailing Address - Phone:508-636-0703
Mailing Address - Fax:
Practice Address - Street 1:176 OLD COUNTY RD
Practice Address - Street 2:
Practice Address - City:WESTPORT
Practice Address - State:MA
Practice Address - Zip Code:02790-1172
Practice Address - Country:US
Practice Address - Phone:508-636-0703
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-03
Last Update Date:2016-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN111559364SP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAS54639Medicare UPIN
MAS54639Medicare UPIN