Provider Demographics
NPI:1992775142
Name:ELCHERT, LORRIE ANN (NURSE PARCTITIONER)
Entity type:Individual
Prefix:
First Name:LORRIE
Middle Name:ANN
Last Name:ELCHERT
Suffix:
Gender:F
Credentials:NURSE PARCTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5705 MONCLOVA RD
Mailing Address - Street 2:
Mailing Address - City:MAUMEE
Mailing Address - State:OH
Mailing Address - Zip Code:43537-1875
Mailing Address - Country:US
Mailing Address - Phone:419-893-3321
Mailing Address - Fax:419-897-1311
Practice Address - Street 1:5705 MONCLOVA RD
Practice Address - Street 2:
Practice Address - City:MAUMEE
Practice Address - State:OH
Practice Address - Zip Code:43537-1875
Practice Address - Country:US
Practice Address - Phone:419-893-3321
Practice Address - Fax:419-897-1311
Is Sole Proprietor?:No
Enumeration Date:2006-01-23
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH08067363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2552287Medicaid
OH2552287Medicaid
OHNP18031Medicare PIN
OHQ40913Medicare UPIN
P00429510Medicare PIN