Provider Demographics
NPI:1972751444
Name:DEBEAU, LORI LYNN (LPN)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:LYNN
Last Name:DEBEAU
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 1:3133 BEAMER RD
Mailing Address - Street 2:
Mailing Address - City:MACHIAS
Mailing Address - State:NY
Mailing Address - Zip Code:14101-9755
Mailing Address - Country:US
Mailing Address - Phone:716-353-2278
Mailing Address - Fax:
Practice Address - Street 1:3133 BEAMER RD
Practice Address - Street 2:
Practice Address - City:MACHIAS
Practice Address - State:NY
Practice Address - Zip Code:14101-9755
Practice Address - Country:US
Practice Address - Phone:716-353-2278
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-08
Last Update Date:2008-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY236489-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse