Provider Demographics
NPI:1831557164
Name:MANDUKE, LORI (RN, NP, IBCLC)
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:
Last Name:MANDUKE
Suffix:
Gender:F
Credentials:RN, NP, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6346 LANGHALL CT
Mailing Address - Street 2:
Mailing Address - City:AGOURA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91301-4114
Mailing Address - Country:US
Mailing Address - Phone:818-822-1919
Mailing Address - Fax:818-991-7500
Practice Address - Street 1:6346 LANGHALL CT
Practice Address - Street 2:
Practice Address - City:AGOURA HILLS
Practice Address - State:CA
Practice Address - Zip Code:91301-4114
Practice Address - Country:US
Practice Address - Phone:818-822-1919
Practice Address - Fax:818-991-7500
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-01
Last Update Date:2016-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA359159163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant