Provider Demographics
NPI:1356234439
Name:PHILLIPS, LORI LYNN
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:LYNN
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6416 SMITH KRAMER ST NE
Mailing Address - Street 2:
Mailing Address - City:HARTVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44632-9137
Mailing Address - Country:US
Mailing Address - Phone:234-226-0662
Mailing Address - Fax:
Practice Address - Street 1:6416 SMITH KRAMER ST NE
Practice Address - Street 2:
Practice Address - City:HARTVILLE
Practice Address - State:OH
Practice Address - Zip Code:44632-9137
Practice Address - Country:US
Practice Address - Phone:234-226-0662
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-29
Last Update Date:2025-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH6027700403243747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant