Provider Demographics
NPI:1174613103
Name:SUNDERLAND, LORELEI M (ARNP)
Entity type:Individual
Prefix:
First Name:LORELEI
Middle Name:M
Last Name:SUNDERLAND
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:LORI
Other - Middle Name:
Other - Last Name:WITT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:325 MAINE STREET
Mailing Address - Street 2:MSO LIBRARY
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66044
Mailing Address - Country:US
Mailing Address - Phone:785-505-2988
Mailing Address - Fax:785-505-5228
Practice Address - Street 1:410 WOODFIELD DR
Practice Address - Street 2:
Practice Address - City:TONGANOXIE
Practice Address - State:KS
Practice Address - Zip Code:66086-5443
Practice Address - Country:US
Practice Address - Phone:785-505-5400
Practice Address - Fax:785-505-5272
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS5345963032363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSKA1087008Medicare PIN