Provider Demographics
NPI:1538433719
Name:PRENDERGAST, LORI (CRNP)
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:
Last Name:PRENDERGAST
Suffix:
Gender:F
Credentials:CRNP
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Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1163 COUNTRY CLUB RD
Mailing Address - Street 2:MELENYZER PAVILLION
Mailing Address - City:MONONGAHELA
Mailing Address - State:PA
Mailing Address - Zip Code:15063-1013
Mailing Address - Country:US
Mailing Address - Phone:724-258-1974
Mailing Address - Fax:724-258-1784
Practice Address - Street 1:1163 COUNTRY CLUB RD
Practice Address - Street 2:MELENYZER PAVILLION
Practice Address - City:MONONGAHELA
Practice Address - State:PA
Practice Address - Zip Code:15063-1013
Practice Address - Country:US
Practice Address - Phone:724-258-1974
Practice Address - Fax:724-258-1784
Is Sole Proprietor?:No
Enumeration Date:2012-03-06
Last Update Date:2015-07-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PASP011646363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily