Provider Demographics
NPI:1508600842
Name:HAYSLETT, LORIE
Entity type:Individual
Prefix:
First Name:LORIE
Middle Name:
Last Name:HAYSLETT
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 1:5436 N GARDEN LN
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24019-2669
Mailing Address - Country:US
Mailing Address - Phone:502-715-8989
Mailing Address - Fax:
Practice Address - Street 1:5436 N GARDEN LN
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24019-2669
Practice Address - Country:US
Practice Address - Phone:502-715-8989
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-21
Last Update Date:2024-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0002087457164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse