Provider Demographics
NPI:1871239210
Name:MCCOLLUMS, LORI (LPN)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:
Last Name:MCCOLLUMS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:132 WALL ST
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:15074-2627
Mailing Address - Country:US
Mailing Address - Phone:724-714-1358
Mailing Address - Fax:
Practice Address - Street 1:2305 WILMINGTON RD STE 3
Practice Address - Street 2:
Practice Address - City:NEW CASTLE
Practice Address - State:PA
Practice Address - Zip Code:16105-1959
Practice Address - Country:US
Practice Address - Phone:724-965-8355
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-09
Last Update Date:2022-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPN286760164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse