Provider Demographics
NPI:1952704777
Name:HALEEN, LORI (RN)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:
Last Name:HALEEN
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 1:72355 ROXBURY DR
Mailing Address - Street 2:
Mailing Address - City:RANCHO MIRAGE
Mailing Address - State:CA
Mailing Address - Zip Code:92270-4038
Mailing Address - Country:US
Mailing Address - Phone:805-815-8547
Mailing Address - Fax:
Practice Address - Street 1:72355 ROXBURY DR
Practice Address - Street 2:
Practice Address - City:RANCHO MIRAGE
Practice Address - State:CA
Practice Address - Zip Code:92270-4038
Practice Address - Country:US
Practice Address - Phone:805-815-8547
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-07
Last Update Date:2014-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN175670164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse