Provider Demographics
NPI:1316910318
Name:PERRY, LORI LEE (CRNP)
Entity type:Individual
Prefix:MS
First Name:LORI
Middle Name:LEE
Last Name:PERRY
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 GUTHRIE SQ
Mailing Address - Street 2:
Mailing Address - City:SAYRE
Mailing Address - State:PA
Mailing Address - Zip Code:18840-1625
Mailing Address - Country:US
Mailing Address - Phone:570-888-5858
Mailing Address - Fax:
Practice Address - Street 1:MANSFIELD UNIVERISTY
Practice Address - Street 2:HEALTH CLINIC
Practice Address - City:MANSFIELD
Practice Address - State:PA
Practice Address - Zip Code:16933
Practice Address - Country:US
Practice Address - Phone:570-662-4350
Practice Address - Fax:570-662-4352
Is Sole Proprietor?:No
Enumeration Date:2006-02-09
Last Update Date:2021-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAUP006948B363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02242886Medicaid
PAGU040009OtherPA MEDICARE GROUP
PACC9269OtherRR MEDICARE GROUP
PA$$$$$$$$$OtherRR MEDICARE PIN
PA$$$$$$$$$OtherRR MEDICARE PIN
P4043Medicare UPIN