Provider Demographics
NPI:1790039980
Name:BILLIARD, LORI T (CRNP)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:T
Last Name:BILLIARD
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:840 WALNUT ST STE 2
Mailing Address - Street 2:
Mailing Address - City:CATASAUQUA
Mailing Address - State:PA
Mailing Address - Zip Code:18032-1018
Mailing Address - Country:US
Mailing Address - Phone:484-272-2788
Mailing Address - Fax:484-526-4658
Practice Address - Street 1:840 WALNUT ST STE 2
Practice Address - Street 2:
Practice Address - City:CATASAUQUA
Practice Address - State:PA
Practice Address - Zip Code:18032-1018
Practice Address - Country:US
Practice Address - Phone:484-272-2788
Practice Address - Fax:484-526-4658
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-09
Last Update Date:2021-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP012503363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner