Provider Demographics
NPI:1295708949
Name:AHRENS, LORI A (MD)
Entity type:Individual
Prefix:DR
First Name:LORI
Middle Name:A
Last Name:AHRENS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LORI
Other - Middle Name:A
Other - Last Name:HOLME
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1320 E DIVISION
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:WA
Mailing Address - Zip Code:98274-4196
Mailing Address - Country:US
Mailing Address - Phone:360-424-6161
Mailing Address - Fax:360-848-1167
Practice Address - Street 1:1320 E DIVISION
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:WA
Practice Address - Zip Code:98274-4196
Practice Address - Country:US
Practice Address - Phone:360-424-6161
Practice Address - Fax:360-848-1167
Is Sole Proprietor?:No
Enumeration Date:2006-02-10
Last Update Date:2012-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD000273742085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA114701OtherL & I
WA8125163Medicaid
WA114701OtherL & I
E72383Medicare UPIN