Provider Demographics
NPI:1124070958
Name:CHANCELLOR, LORI A (CRNA)
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:A
Last Name:CHANCELLOR
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:LORI
Other - Middle Name:C
Other - Last Name:WHITWORTH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CRNA
Mailing Address - Street 1:2000 E LAMAR BLVD.
Mailing Address - Street 2:STE 400
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76006-7353
Mailing Address - Country:US
Mailing Address - Phone:817-861-3994
Mailing Address - Fax:
Practice Address - Street 1:2000 E LAMAR BLVD
Practice Address - Street 2:STE 400
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76006-7346
Practice Address - Country:US
Practice Address - Phone:817-861-3994
Practice Address - Fax:682-227-6869
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2014-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX248515367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX177537101Medicaid
TX177537101Medicaid