Provider Demographics
NPI:1932504115
Name:FARMER, LORI (PA-C)
Entity Type:Individual
Prefix:MS
First Name:LORI
Middle Name:
Last Name:FARMER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:62115 MEADOW WAY E
Mailing Address - Street 2:
Mailing Address - City:ENUMCLAW
Mailing Address - State:WA
Mailing Address - Zip Code:98022-8074
Mailing Address - Country:US
Mailing Address - Phone:253-569-8079
Mailing Address - Fax:
Practice Address - Street 1:1623 N 1ST ST
Practice Address - Street 2:
Practice Address - City:HERMISTON
Practice Address - State:OR
Practice Address - Zip Code:97838-1106
Practice Address - Country:US
Practice Address - Phone:458-300-9014
Practice Address - Fax:458-300-9015
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-29
Last Update Date:2023-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60511314363A00000X
ORPA216285363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant