Provider Demographics
NPI:1538147624
Name:COREY, LOIS ANN (CRNA)
Entity type:Individual
Prefix:
First Name:LOIS
Middle Name:ANN
Last Name:COREY
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9694 GALLEY CT
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33919-3177
Mailing Address - Country:US
Mailing Address - Phone:239-989-3344
Mailing Address - Fax:
Practice Address - Street 1:9694 GALLEY CT
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33919-3177
Practice Address - Country:US
Practice Address - Phone:239-989-3344
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-09
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP831282367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLG1343Medicare ID - Type Unspecified