Provider Demographics
NPI:1144462706
Name:WILLKE, LORI ANN (RN)
Entity type:Individual
Prefix:MRS
First Name:LORI
Middle Name:ANN
Last Name:WILLKE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6541 WILLOW DALE CT
Mailing Address - Street 2:
Mailing Address - City:LIBERTY TWP
Mailing Address - State:OH
Mailing Address - Zip Code:45011-9077
Mailing Address - Country:US
Mailing Address - Phone:513-863-8922
Mailing Address - Fax:513-863-0269
Practice Address - Street 1:6541 WILLOW DALE CT
Practice Address - Street 2:
Practice Address - City:LIBERTY TWP
Practice Address - State:OH
Practice Address - Zip Code:45011-9077
Practice Address - Country:US
Practice Address - Phone:513-863-8922
Practice Address - Fax:513-863-0269
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-28
Last Update Date:2009-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.198559163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse