Provider Demographics
NPI:1538216080
Name:SAVARESE, LORRI NICOLLE (NP)
Entity type:Individual
Prefix:
First Name:LORRI
Middle Name:NICOLLE
Last Name:SAVARESE
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 1:2 MONDAVI LN
Mailing Address - Street 2:
Mailing Address - City:EAST SETAUKET
Mailing Address - State:NY
Mailing Address - Zip Code:11733-2654
Mailing Address - Country:US
Mailing Address - Phone:631-675-6540
Mailing Address - Fax:
Practice Address - Street 1:306 SHEEP PASTURE RD
Practice Address - Street 2:
Practice Address - City:EAST SETAUKET
Practice Address - State:NY
Practice Address - Zip Code:11733-3611
Practice Address - Country:US
Practice Address - Phone:631-675-6540
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-05
Last Update Date:2016-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY302696363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health