Provider Demographics
NPI:1255393328
Name:MARKHAM, LORI ANN (RNC, MSN, NNP, CCRN)
Entity type:Individual
Prefix:MS
First Name:LORI
Middle Name:ANN
Last Name:MARKHAM
Suffix:
Gender:F
Credentials:RNC, MSN, NNP, CCRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4706 NE 187TH PL
Mailing Address - Street 2:
Mailing Address - City:LAKE FOREST PARK
Mailing Address - State:WA
Mailing Address - Zip Code:98155-2924
Mailing Address - Country:US
Mailing Address - Phone:206-922-3636
Mailing Address - Fax:206-987-7126
Practice Address - Street 1:4800 SAND POINT WAY NE
Practice Address - Street 2:MS CSB 240
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98105-3901
Practice Address - Country:US
Practice Address - Phone:206-987-2248
Practice Address - Fax:206-987-7126
Is Sole Proprietor?:No
Enumeration Date:2006-04-04
Last Update Date:2009-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX667475363LN0005X
WAAP30007687363LN0005X, 363LN0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0005XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal, Critical Care
No363LN0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8878231Medicare PIN
WA8869641Medicare PIN