Provider Demographics
NPI:1174592109
Name:PEACE, LORI (RN)
Entity type:Individual
Prefix:MRS
First Name:LORI
Middle Name:
Last Name:PEACE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MS
Other - First Name:LORI
Other - Middle Name:
Other - Last Name:NEWMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:140 PINEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:ELYRIA
Mailing Address - State:OH
Mailing Address - Zip Code:44035-6032
Mailing Address - Country:US
Mailing Address - Phone:440-723-7208
Mailing Address - Fax:
Practice Address - Street 1:140 PINEWOOD DR
Practice Address - Street 2:
Practice Address - City:ELYRIA
Practice Address - State:OH
Practice Address - Zip Code:44035-6032
Practice Address - Country:US
Practice Address - Phone:440-723-7208
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-14
Last Update Date:2016-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN270463163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2065812Medicaid