Provider Demographics
NPI:1073962890
Name:BANNON, LORI ANN (NP)
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:ANN
Last Name:BANNON
Suffix:
Gender:
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1020 FIRST COLONIAL RD STE A
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23454-3078
Mailing Address - Country:US
Mailing Address - Phone:757-395-1850
Mailing Address - Fax:
Practice Address - Street 1:2225 ADMIRAL CIR
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23451-1733
Practice Address - Country:US
Practice Address - Phone:577-540-5537
Practice Address - Fax:757-794-4781
Is Sole Proprietor?:No
Enumeration Date:2016-06-13
Last Update Date:2025-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024173629363LP0808X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology