Provider Demographics
NPI:1801409792
Name:LORI DAVIS, NP IN FAMILY HEALTH PLLC
Entity Type:Organization
Organization Name:LORI DAVIS, NP IN FAMILY HEALTH PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LORI
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:607-269-5519
Mailing Address - Street 1:317 N AURORA ST STE 200A
Mailing Address - Street 2:
Mailing Address - City:ITHACA
Mailing Address - State:NY
Mailing Address - Zip Code:14850-4201
Mailing Address - Country:US
Mailing Address - Phone:607-269-5519
Mailing Address - Fax:
Practice Address - Street 1:317 N AURORA ST STE 200A
Practice Address - Street 2:
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850-4201
Practice Address - Country:US
Practice Address - Phone:607-269-5519
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-28
Last Update Date:2020-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center