Provider Demographics
NPI:1679097588
Name:ANDERSON, LORIE ANN (APRN, CNP)
Entity type:Individual
Prefix:MRS
First Name:LORIE
Middle Name:ANN
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:APRN, CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2413 FALESCO RD SE
Mailing Address - Street 2:
Mailing Address - City:RIO RANCHO
Mailing Address - State:NM
Mailing Address - Zip Code:87124-8792
Mailing Address - Country:US
Mailing Address - Phone:580-276-6841
Mailing Address - Fax:505-727-8768
Practice Address - Street 1:500 WALTER ST NE STE 308
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87102
Practice Address - Country:US
Practice Address - Phone:505-727-8360
Practice Address - Fax:580-727-8768
Is Sole Proprietor?:No
Enumeration Date:2017-08-01
Last Update Date:2024-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71014675A363LA2100X
OK109536363LF0000X
NM55150363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care