Provider Demographics
NPI:1881820298
Name:LORACK, LISA KAY (CNA)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:KAY
Last Name:LORACK
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:307 N. PARK
Mailing Address - Street 2:
Mailing Address - City:OLDS
Mailing Address - State:IA
Mailing Address - Zip Code:52647
Mailing Address - Country:US
Mailing Address - Phone:319-254-2414
Mailing Address - Fax:
Practice Address - Street 1:307 N PARK
Practice Address - Street 2:
Practice Address - City:OLDS
Practice Address - State:IA
Practice Address - Zip Code:52647
Practice Address - Country:US
Practice Address - Phone:319-254-2414
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-01
Last Update Date:2009-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA116702376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide