Provider Demographics
NPI:1780790394
Name:BAZEY, LORI A (CRNA)
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:A
Last Name:BAZEY
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3366 DESERT STAR LN
Mailing Address - Street 2:
Mailing Address - City:GRAND FORKS
Mailing Address - State:ND
Mailing Address - Zip Code:58201-5823
Mailing Address - Country:US
Mailing Address - Phone:701-746-7441
Mailing Address - Fax:701-746-7447
Practice Address - Street 1:3035 DEMERS AVE
Practice Address - Street 2:
Practice Address - City:GRAND FORKS
Practice Address - State:ND
Practice Address - Zip Code:58201-4040
Practice Address - Country:US
Practice Address - Phone:701-775-3151
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2008-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDR22456367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN010M8BAOtherBCBS
ND11931Medicaid
ND021269OtherBCBS
430010862OtherRR MEDICARE
MN661345400Medicaid
430010862OtherRR MEDICARE