Provider Demographics
NPI:1386905982
Name:SILVESTRE, LORIE
Entity type:Individual
Prefix:
First Name:LORIE
Middle Name:
Last Name:SILVESTRE
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:PO BOX 21
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:PA
Mailing Address - Zip Code:15537-0021
Mailing Address - Country:US
Mailing Address - Phone:888-651-0480
Mailing Address - Fax:888-651-0480
Practice Address - Street 1:189 N MILK AND WATER RD
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:PA
Practice Address - Zip Code:15537-8438
Practice Address - Country:US
Practice Address - Phone:888-651-0480
Practice Address - Fax:888-651-0480
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-31
Last Update Date:2012-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor