Provider Demographics
NPI:1952695934
Name:JERDEE, LORI LYNN (RN)
Entity Type:Individual
Prefix:MS
First Name:LORI
Middle Name:LYNN
Last Name:JERDEE
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 1:10700 LUMBERJACK RD NW
Mailing Address - Street 2:
Mailing Address - City:PUPOSKY
Mailing Address - State:MN
Mailing Address - Zip Code:56667-6827
Mailing Address - Country:US
Mailing Address - Phone:218-407-0008
Mailing Address - Fax:
Practice Address - Street 1:10700 LUMBERJACK RD NW
Practice Address - Street 2:
Practice Address - City:PUPOSKY
Practice Address - State:MN
Practice Address - Zip Code:56667-6827
Practice Address - Country:US
Practice Address - Phone:218-407-0008
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-07
Last Update Date:2011-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR126149-5163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health