Provider Demographics
NPI:1023257557
Name:EDMOND, LORI ANN (LPN)
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:ANN
Last Name:EDMOND
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:LORI
Other - Middle Name:ANN
Other - Last Name:MOORE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:3717 RIVIERA
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97402-8764
Mailing Address - Country:US
Mailing Address - Phone:541-513-9508
Mailing Address - Fax:
Practice Address - Street 1:3717 RIVIERA
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97402-8764
Practice Address - Country:US
Practice Address - Phone:541-513-9508
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-05
Last Update Date:2009-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR095005088LPN164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse