Provider Demographics
NPI:1730309428
Name:TREIBER, LORI LYNN (CNP)
Entity Type:Individual
Prefix:MRS
First Name:LORI
Middle Name:LYNN
Last Name:TREIBER
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:MS
Other - First Name:LORI
Other - Middle Name:LYNN
Other - Last Name:KALAVITY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNP
Mailing Address - Street 1:4893 GRAFTON RD
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:OH
Mailing Address - Zip Code:44212-1020
Mailing Address - Country:US
Mailing Address - Phone:330-412-9766
Mailing Address - Fax:
Practice Address - Street 1:16600 W SPRAGUE RD STE 120
Practice Address - Street 2:
Practice Address - City:MIDDLEBURG HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44130-6300
Practice Address - Country:US
Practice Address - Phone:440-826-0599
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2015-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHNP-09276363LF0000X
OHRN214424363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3107668Medicaid