Provider Demographics
NPI:1366749657
Name:ROBERTSON, LORI SHANNON
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:SHANNON
Last Name:ROBERTSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5865 TYRONE RD STE 102
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89502-6266
Mailing Address - Country:US
Mailing Address - Phone:775-800-1136
Mailing Address - Fax:775-800-1382
Practice Address - Street 1:5865 TYRONE RD STE 102
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-6266
Practice Address - Country:US
Practice Address - Phone:775-800-1136
Practice Address - Fax:775-800-1382
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-22
Last Update Date:2022-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator