Provider Demographics
NPI:1366726309
Name:TRADER, LORI A (LPN)
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:A
Last Name:TRADER
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:LE ROY
Mailing Address - State:NY
Mailing Address - Zip Code:14482-1434
Mailing Address - Country:US
Mailing Address - Phone:585-297-9778
Mailing Address - Fax:
Practice Address - Street 1:20 MADISON AVE
Practice Address - Street 2:
Practice Address - City:LE ROY
Practice Address - State:NY
Practice Address - Zip Code:14482-1434
Practice Address - Country:US
Practice Address - Phone:585-297-9778
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-10
Last Update Date:2011-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY306729164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse