Provider Demographics
NPI:1720310170
Name:PETTERSON, LORRI M (RN)
Entity Type:Individual
Prefix:MRS
First Name:LORRI
Middle Name:M
Last Name:PETTERSON
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 1:863 NE HIDDEN VALLEY DR UNIT 1
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-6575
Mailing Address - Country:US
Mailing Address - Phone:541-350-3945
Mailing Address - Fax:
Practice Address - Street 1:863 NE HIDDEN VALLEY DR UNIT 1
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-6575
Practice Address - Country:US
Practice Address - Phone:541-350-3945
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-10
Last Update Date:2010-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR200941831163WM0705X
OR200830291164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical
No164W00000XNursing Service ProvidersLicensed Practical Nurse