Provider Demographics
NPI:1699099432
Name:SHULTZ, LORI A (LPN)
Entity type:Individual
Prefix:MS
First Name:LORI
Middle Name:A
Last Name:SHULTZ
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3322 W MAIN RD
Mailing Address - Street 2:LOT 48
Mailing Address - City:BATAVIA
Mailing Address - State:NY
Mailing Address - Zip Code:14020-9476
Mailing Address - Country:US
Mailing Address - Phone:585-219-4807
Mailing Address - Fax:
Practice Address - Street 1:3322 W MAIN RD
Practice Address - Street 2:LOT 48
Practice Address - City:BATAVIA
Practice Address - State:NY
Practice Address - Zip Code:14020-9476
Practice Address - Country:US
Practice Address - Phone:585-219-4807
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-23
Last Update Date:2010-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY271698-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse