Provider Demographics
NPI:1982817953
Name:REPP, LORI A (GNP)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:A
Last Name:REPP
Suffix:
Gender:F
Credentials:GNP
Other - Prefix:
Other - First Name:LORI
Other - Middle Name:A
Other - Last Name:COPELAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:851 E 5TH ST STE 152
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:MO
Mailing Address - Zip Code:63090-3128
Mailing Address - Country:US
Mailing Address - Phone:636-861-7880
Mailing Address - Fax:
Practice Address - Street 1:851 E 5TH ST STE 152
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:MO
Practice Address - Zip Code:63090-3128
Practice Address - Country:US
Practice Address - Phone:636-861-7880
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-07
Last Update Date:2022-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO112881363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO424726511Medicaid
MO424726511Medicaid
834322943Medicare PIN