Provider Demographics
NPI:1457393662
Name:KNOWLES, LORI ANN (CPNP)
Entity Type:Individual
Prefix:
First Name:LORI ANN
Middle Name:
Last Name:KNOWLES
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 UNION ST
Mailing Address - Street 2:MAINE COAST MEMORIAL HOSPITAL
Mailing Address - City:ELLSWORTH
Mailing Address - State:ME
Mailing Address - Zip Code:04605-1586
Mailing Address - Country:US
Mailing Address - Phone:207-664-7744
Mailing Address - Fax:207-664-7724
Practice Address - Street 1:32 RESORT WAY
Practice Address - Street 2:MAINE COAST PEDIATRICS
Practice Address - City:ELLSWORTH
Practice Address - State:ME
Practice Address - Zip Code:04605-1717
Practice Address - Country:US
Practice Address - Phone:207-664-7744
Practice Address - Fax:207-664-7724
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2010-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MER027749363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME266060099Medicaid
MENP2261Medicare PIN
MEP01029Medicare UPIN