Provider Demographics
NPI:1386451839
Name:FERNANDEZ, LORI A (STNA)
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:A
Last Name:FERNANDEZ
Suffix:
Gender:F
Credentials:STNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:851 N STATE ST
Mailing Address - Street 2:
Mailing Address - City:PAINESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44077-4262
Mailing Address - Country:US
Mailing Address - Phone:440-391-2621
Mailing Address - Fax:
Practice Address - Street 1:851 N STATE ST
Practice Address - Street 2:
Practice Address - City:PAINESVILLE
Practice Address - State:OH
Practice Address - Zip Code:44077-4262
Practice Address - Country:US
Practice Address - Phone:440-391-2621
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-17
Last Update Date:2024-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH401914431116376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide