Provider Demographics
NPI:1922061852
Name:O'SHAUGHNESSY, LORI M (CRNP)
Entity Type:Individual
Prefix:MS
First Name:LORI
Middle Name:M
Last Name:O'SHAUGHNESSY
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 1:100 N ACADEMY AVE
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17822-3034
Mailing Address - Country:US
Mailing Address - Phone:570-271-6144
Mailing Address - Fax:570-271-6578
Practice Address - Street 1:HCR 67
Practice Address - Street 2:RT 35
Practice Address - City:MIFFLIN
Practice Address - State:PA
Practice Address - Zip Code:17058-9801
Practice Address - Country:US
Practice Address - Phone:717-436-8986
Practice Address - Fax:717-436-5392
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP008415363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA082945Medicare ID - Type Unspecified
S39766Medicare UPIN