Provider Demographics
NPI:1649521352
Name:PELOSI, LORI (APRN)
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:
Last Name:PELOSI
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:619 GUERNSEYTOWN RD
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06795-1820
Mailing Address - Country:US
Mailing Address - Phone:203-525-8052
Mailing Address - Fax:
Practice Address - Street 1:57 PLAINS RD SUITE 1 A
Practice Address - Street 2:UNIT 2
Practice Address - City:MILFORD
Practice Address - State:CT
Practice Address - Zip Code:06461-2573
Practice Address - Country:US
Practice Address - Phone:203-465-6537
Practice Address - Fax:203-900-0672
Is Sole Proprietor?:No
Enumeration Date:2012-09-21
Last Update Date:2023-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT005149363LP0808X, 363L00000X, 363LF0000X
CT5149363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily