Provider Demographics
NPI:1700771276
Name:NELLIS, LORI (RN)
Entity type:Individual
Prefix:MRS
First Name:LORI
Middle Name:
Last Name:NELLIS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:883 UNION MILLS RD
Mailing Address - Street 2:
Mailing Address - City:BROADALBIN
Mailing Address - State:NY
Mailing Address - Zip Code:12025-1992
Mailing Address - Country:US
Mailing Address - Phone:518-774-5447
Mailing Address - Fax:
Practice Address - Street 1:100 BRIDGE ST
Practice Address - Street 2:
Practice Address - City:BROADALBIN
Practice Address - State:NY
Practice Address - Zip Code:12025-2193
Practice Address - Country:US
Practice Address - Phone:518-954-2631
Practice Address - Fax:855-975-2702
Is Sole Proprietor?:No
Enumeration Date:2025-06-12
Last Update Date:2025-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY657836163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse