Provider Demographics
NPI:1063577245
Name:PECHA, LORI NEURENE (LD)
Entity type:Individual
Prefix:MRS
First Name:LORI
Middle Name:NEURENE
Last Name:PECHA
Suffix:
Gender:F
Credentials:LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12501 S KEENEY RD
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99224-9205
Mailing Address - Country:US
Mailing Address - Phone:509-999-0615
Mailing Address - Fax:509-443-1998
Practice Address - Street 1:12501 S KEENEY RD
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99224-9205
Practice Address - Country:US
Practice Address - Phone:509-999-0615
Practice Address - Fax:509-443-1998
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-27
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADN00000330122400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122400000XDental ProvidersDenturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5040613Medicaid
WA5052584Medicaid