Provider Demographics
NPI:1316248909
Name:DICK, LORI KAYE (CNA)
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:KAYE
Last Name:DICK
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5521 RAY DRIVE
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46835-1674
Mailing Address - Country:US
Mailing Address - Phone:260-494-5420
Mailing Address - Fax:
Practice Address - Street 1:5521 RAY DR
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46835-1674
Practice Address - Country:US
Practice Address - Phone:260-494-5420
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-12
Last Update Date:2010-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INCNA0908122376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide