Provider Demographics
NPI:1265967020
Name:COLLIER PURCY, LORENE
Entity type:Individual
Prefix:
First Name:LORENE
Middle Name:
Last Name:COLLIER PURCY
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 1:200 S CROWLEY RD
Mailing Address - Street 2:#285
Mailing Address - City:CROWLEY
Mailing Address - State:TX
Mailing Address - Zip Code:76036-3251
Mailing Address - Country:US
Mailing Address - Phone:817-405-9670
Mailing Address - Fax:
Practice Address - Street 1:797 KEEL LINE DR
Practice Address - Street 2:
Practice Address - City:CROWLEY
Practice Address - State:TX
Practice Address - Zip Code:76036-3452
Practice Address - Country:US
Practice Address - Phone:817-405-9670
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-28
Last Update Date:2017-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker