Provider Demographics
NPI:1205970100
Name:ECONOMOS, LORI
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:
Last Name:ECONOMOS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:507 WINTERTHUR LN
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19711-4131
Mailing Address - Country:US
Mailing Address - Phone:302-383-7766
Mailing Address - Fax:
Practice Address - Street 1:975 BALTIMORE PIKE
Practice Address - Street 2:
Practice Address - City:GLEN MILLS
Practice Address - State:PA
Practice Address - Zip Code:19342-1016
Practice Address - Country:US
Practice Address - Phone:302-596-4999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-16
Last Update Date:2023-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEL10015837163WS0200X
DELG0000815363LF0000X
MDAC002487363LF0000X
PASP021834363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WS0200XNursing Service ProvidersRegistered NurseSchool