Provider Demographics
NPI:1285605808
Name:DAVISON, LORRI LYNN (APRN)
Entity type:Individual
Prefix:
First Name:LORRI
Middle Name:LYNN
Last Name:DAVISON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1242 N TURNER AVE
Mailing Address - Street 2:
Mailing Address - City:HASTINGS
Mailing Address - State:NE
Mailing Address - Zip Code:68901-7669
Mailing Address - Country:US
Mailing Address - Phone:402-463-7647
Mailing Address - Fax:
Practice Address - Street 1:815 N KANSAS AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:HASTINGS
Practice Address - State:NE
Practice Address - Zip Code:68901-4470
Practice Address - Country:US
Practice Address - Phone:402-460-5899
Practice Address - Fax:402-460-5619
Is Sole Proprietor?:No
Enumeration Date:2006-01-31
Last Update Date:2008-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE110672363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE245521OtherMIDLANDS CHOICE NUMBER
NE37969OtherBC/BS
NE10025662600Medicaid
NE10025662600Medicaid
NEQ34075Medicare UPIN