Provider Demographics
NPI:1699071027
Name:DETTMER, LORI LINN (ARNP)
Entity type:Individual
Prefix:MS
First Name:LORI
Middle Name:LINN
Last Name:DETTMER
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7024 NORDIC DR
Mailing Address - Street 2:
Mailing Address - City:CEDAR FALLS
Mailing Address - State:IA
Mailing Address - Zip Code:50613-6309
Mailing Address - Country:US
Mailing Address - Phone:319-266-3127
Mailing Address - Fax:
Practice Address - Street 1:7024 NORDIC DR
Practice Address - Street 2:
Practice Address - City:CEDAR FALLS
Practice Address - State:IA
Practice Address - Zip Code:50613-6309
Practice Address - Country:US
Practice Address - Phone:319-266-3127
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-02
Last Update Date:2023-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA086955363LX0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0106XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerOccupational Health