Provider Demographics
NPI:1356890834
Name:PISTONE, LORIE ELLEN
Entity type:Individual
Prefix:
First Name:LORIE
Middle Name:ELLEN
Last Name:PISTONE
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 1:940 SWEETWATER LN
Mailing Address - Street 2:APT. 516
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33431-7132
Mailing Address - Country:US
Mailing Address - Phone:561-465-3431
Mailing Address - Fax:
Practice Address - Street 1:1880 N CONGRESS AVE
Practice Address - Street 2:STE 303A
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33426-8671
Practice Address - Country:US
Practice Address - Phone:561-734-8111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-26
Last Update Date:2016-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9386019363L00000X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology