Provider Demographics
NPI:1164470498
Name:CETRINO, LORI A (CRNA)
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:A
Last Name:CETRINO
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:LORI
Other - Middle Name:A
Other - Last Name:MACKINNON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:199 REEDSDALE RD
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:MA
Mailing Address - Zip Code:02186-3926
Mailing Address - Country:US
Mailing Address - Phone:617-667-3364
Mailing Address - Fax:617-667-5013
Practice Address - Street 1:199 REEDSDALE RD
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:MA
Practice Address - Zip Code:02186-3926
Practice Address - Country:US
Practice Address - Phone:617-667-3364
Practice Address - Fax:617-667-5013
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2016-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIRNA36610367500000X
MARN205261367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI007057518Medicare ID - Type UnspecifiedPROVIDER NUMBER