Provider Demographics
NPI:1891007340
Name:PURDY, LORIE LEE (NURSE PRACTITIONER)
Entity type:Individual
Prefix:MRS
First Name:LORIE
Middle Name:LEE
Last Name:PURDY
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5013 GOLDEN WEST AVE
Mailing Address - Street 2:
Mailing Address - City:TEMPLE CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91780-3939
Mailing Address - Country:US
Mailing Address - Phone:626-286-3271
Mailing Address - Fax:
Practice Address - Street 1:1401 S BALDWIN AVE
Practice Address - Street 2:
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91007-7922
Practice Address - Country:US
Practice Address - Phone:626-445-1284
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-12
Last Update Date:2010-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP19045363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily