Provider Demographics
NPI:1538710090
Name:DANIEL, LORI DIAN (FNP-C)
Entity type:Individual
Prefix:MRS
First Name:LORI
Middle Name:DIAN
Last Name:DANIEL
Suffix:
Gender:F
Credentials:FNP-C
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 102
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:IN
Mailing Address - Zip Code:47558-0102
Mailing Address - Country:US
Mailing Address - Phone:812-486-2842
Mailing Address - Fax:812-486-2784
Practice Address - Street 1:542 N 3RD ST
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:IN
Practice Address - Zip Code:47558-5745
Practice Address - Country:US
Practice Address - Phone:812-486-2842
Practice Address - Fax:812-486-2784
Is Sole Proprietor?:No
Enumeration Date:2019-09-26
Last Update Date:2019-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28150963A163W00000X
IN71009476A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse