Provider Demographics
NPI:1134717705
Name:SHOEMAKER, LORI (REGISTERED NURSE)
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:
Last Name:SHOEMAKER
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 EDMAR CT
Mailing Address - Street 2:
Mailing Address - City:HENRIETTA
Mailing Address - State:NY
Mailing Address - Zip Code:14467-9624
Mailing Address - Country:US
Mailing Address - Phone:585-489-8064
Mailing Address - Fax:
Practice Address - Street 1:22 EDMAR CT
Practice Address - Street 2:
Practice Address - City:HENRIETTA
Practice Address - State:NY
Practice Address - Zip Code:14467-9624
Practice Address - Country:US
Practice Address - Phone:585-489-8064
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-08
Last Update Date:2021-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY436343163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse