Provider Demographics
NPI:1871503839
Name:STAMM, LORI JAYNE
Entity Type:Individual
Prefix:MS
First Name:LORI
Middle Name:JAYNE
Last Name:STAMM
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:DRUPATIE
Other - Middle Name:MADOO
Other - Last Name:SCHOBERG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:17029 CLEAR SPRING TER
Mailing Address - Street 2:
Mailing Address - City:MINNETONKA
Mailing Address - State:MN
Mailing Address - Zip Code:55345-4318
Mailing Address - Country:US
Mailing Address - Phone:952-975-0229
Mailing Address - Fax:952-975-0229
Practice Address - Street 1:17029 CLEAR SPRING TER
Practice Address - Street 2:
Practice Address - City:MINNETONKA
Practice Address - State:MN
Practice Address - Zip Code:55345-4318
Practice Address - Country:US
Practice Address - Phone:952-975-0229
Practice Address - Fax:952-975-0229
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR105016-9163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health