Provider Demographics
NPI:1841635364
Name:ESTESS, LORI RENEE (IDC)
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:RENEE
Last Name:ESTESS
Suffix:
Gender:F
Credentials:IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1ST MARINE AIRCRAF WING
Mailing Address - Street 2:ATTN. WING SURGEON UNIT 37101
Mailing Address - City:FPO
Mailing Address - State:AP
Mailing Address - Zip Code:96373-7107
Mailing Address - Country:US
Mailing Address - Phone:81804-669-5040
Mailing Address - Fax:
Practice Address - Street 1:1ST MARINE AIRCRAFT WING
Practice Address - Street 2:UNIT 37101
Practice Address - City:FPO
Practice Address - State:AP
Practice Address - Zip Code:96373-7107
Practice Address - Country:US
Practice Address - Phone:81804-669-5040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-10
Last Update Date:2013-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman
Provider Identifiers
StateIdentifier IDID TypeIssuer
1710-1002XOtherIDC