Provider Demographics
NPI:1770512618
Name:PRESTON, LORI A (CRNA)
Entity Type:Individual
Prefix:MS
First Name:LORI
Middle Name:A
Last Name:PRESTON
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301C US ROUTE ONE
Mailing Address - Street 2:MAINE MEDICAL PARTNERS
Mailing Address - City:SCARBOROUGH
Mailing Address - State:ME
Mailing Address - Zip Code:04074
Mailing Address - Country:US
Mailing Address - Phone:207-396-8600
Mailing Address - Fax:740-446-5982
Practice Address - Street 1:35 MILES ST
Practice Address - Street 2:
Practice Address - City:DAMARISCOTTA
Practice Address - State:ME
Practice Address - Zip Code:04543-4047
Practice Address - Country:US
Practice Address - Phone:207-563-4837
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-02
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV50684367500000X
OH19248367500000X
MERNA143018367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME1770512618Medicaid
WV001706470OtherMSBCBS GROUP
WV0069300000Medicaid
OH2058204Medicaid
WVDA0096OtherRR MEDICARE
WV2460484Medicaid
WV001720720OtherMSBCBS
OH2460484Medicaid
WV27005299700OtherBRICKSTREET
OHP00794072OtherRAILROAD MEDICARE
WV001720720OtherBCBS
WV0207026000Medicaid
WV27005299700OtherWORKERS COMP
WV270052997003OtherTRICARE
WVP00273112OtherRR MEDICARE
OHH105811Medicare PIN
WVDA0096OtherRR MEDICARE