Provider Demographics
NPI:1922145283
Name:FIRESTONE, LORI ANN (NP)
Entity type:Individual
Prefix:MRS
First Name:LORI
Middle Name:ANN
Last Name:FIRESTONE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3555 KEITH ST NW
Mailing Address - Street 2:SUITE 102
Mailing Address - City:CLEVELAND
Mailing Address - State:TN
Mailing Address - Zip Code:37312-4375
Mailing Address - Country:US
Mailing Address - Phone:423-728-2282
Mailing Address - Fax:
Practice Address - Street 1:3555 KEITH ST NW
Practice Address - Street 2:SUITE 102
Practice Address - City:CLEVELAND
Practice Address - State:TN
Practice Address - Zip Code:37312-4375
Practice Address - Country:US
Practice Address - Phone:423-728-2282
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2009-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRN116297163W00000X
TNAPN7647363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4186544OtherBCBS
TN38085922Medicare PIN