Provider Demographics
NPI:1588667026
Name:MEJER, LORRAINE (MSN)
Entity type:Individual
Prefix:MS
First Name:LORRAINE
Middle Name:
Last Name:MEJER
Suffix:
Gender:F
Credentials:MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2410 N GLENDALE DR STE A
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46804-8909
Mailing Address - Country:US
Mailing Address - Phone:260-432-5181
Mailing Address - Fax:260-432-5692
Practice Address - Street 1:2410 N GLENDALE DR STE A
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46804-8909
Practice Address - Country:US
Practice Address - Phone:260-432-5181
Practice Address - Fax:260-432-5692
Is Sole Proprietor?:No
Enumeration Date:2005-05-28
Last Update Date:2011-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN35000677A106H00000X
IN3400353A1041C0700X
IN28050431A163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN1581OtherPHP
IN000000175091OtherANTHEM BCBS
272094000OtherMAGELLAN
272094000OtherMAGELLAN
IN665610DMedicare ID - Type UnspecifiedIN MEDICARE