Provider Demographics
NPI:1881996866
Name:HUSTWAITE, LORRI L
Entity type:Individual
Prefix:
First Name:LORRI
Middle Name:L
Last Name:HUSTWAITE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 HERITAGE WAY
Mailing Address - Street 2:
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901-3101
Mailing Address - Country:US
Mailing Address - Phone:406-752-5027
Mailing Address - Fax:406-257-5554
Practice Address - Street 1:160 HERITAGE WAY
Practice Address - Street 2:
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-3101
Practice Address - Country:US
Practice Address - Phone:406-752-5027
Practice Address - Fax:406-257-5554
Is Sole Proprietor?:No
Enumeration Date:2010-11-24
Last Update Date:2010-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician