Basic Information
| Provider Information | |||||||||
| NPI: | 1275086720 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | VANDEVOORT | ||||||||
| FirstName: | LORI | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8109 HIGHWAY X | ||||||||
| Address2: | |||||||||
| City: | THREE LAKES | ||||||||
| State: | WI | ||||||||
| PostalCode: | 545629285 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 1630 CHIPPEWA DR | ||||||||
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| City: | RHINELANDER | ||||||||
| State: | WI | ||||||||
| PostalCode: | 545019503 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7153615480 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/02/2016 | ||||||||
| LastUpdateDate: | 08/02/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 7144-33 | WI | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.