Provider Demographics
NPI:1760029250
Name:DODSON, LORRIELLE LEEANNA
Entity Type:Individual
Prefix:
First Name:LORRIELLE
Middle Name:LEEANNA
Last Name:DODSON
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 1:1682 ASH CT APT 183
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:OH
Mailing Address - Zip Code:44240-7646
Mailing Address - Country:US
Mailing Address - Phone:330-842-8111
Mailing Address - Fax:
Practice Address - Street 1:1682 ASH CT APT 183
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:OH
Practice Address - Zip Code:44240-7646
Practice Address - Country:US
Practice Address - Phone:330-842-8111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-04
Last Update Date:2019-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program