Provider Demographics
NPI:1982498945
Name:WESTRA, LORI BETH (APRN, PMHNP)
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:BETH
Last Name:WESTRA
Suffix:
Gender:
Credentials:APRN, PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3609 WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:MATTOON
Mailing Address - State:IL
Mailing Address - Zip Code:61938-2040
Mailing Address - Country:US
Mailing Address - Phone:314-610-6718
Mailing Address - Fax:314-610-6718
Practice Address - Street 1:3609 WESTERN AVE
Practice Address - Street 2:
Practice Address - City:MATTOON
Practice Address - State:IL
Practice Address - Zip Code:61938-2040
Practice Address - Country:US
Practice Address - Phone:314-610-6718
Practice Address - Fax:314-610-6718
Is Sole Proprietor?:No
Enumeration Date:2025-04-07
Last Update Date:2025-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program