Provider Demographics
NPI:1700926185
Name:BACON, LORIN J (ACNP)
Entity Type:Individual
Prefix:MS
First Name:LORIN
Middle Name:J
Last Name:BACON
Suffix:
Gender:F
Credentials:ACNP
Other - Prefix:MS
Other - First Name:LORI
Other - Middle Name:J
Other - Last Name:BACON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ACNP
Mailing Address - Street 1:401 GARDNER CT
Mailing Address - Street 2:
Mailing Address - City:FOLSOM
Mailing Address - State:CA
Mailing Address - Zip Code:95630-9567
Mailing Address - Country:US
Mailing Address - Phone:916-353-1105
Mailing Address - Fax:
Practice Address - Street 1:2345 FAIR OAKS BLVD # 2853
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95825-4708
Practice Address - Country:US
Practice Address - Phone:916-480-6526
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2011-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA422161363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care