Basic Information
| Provider Information | |||||||||
| NPI: | 1700154929 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HELGESEN | ||||||||
| FirstName: | LORI | ||||||||
| MiddleName: | ELLEN | ||||||||
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| Credential: | APRN | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 449 | ||||||||
| Address2: | |||||||||
| City: | MARIETTA | ||||||||
| State: | OH | ||||||||
| PostalCode: | 457500449 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7403744500 | ||||||||
| FaxNumber: | 7403745887 | ||||||||
| Practice Location | |||||||||
| Address1: | 40 WHITE OAK PROFESSIONAL CTR | ||||||||
| Address2: | |||||||||
| City: | VINCENT | ||||||||
| State: | OH | ||||||||
| PostalCode: | 457849117 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7406782374 | ||||||||
| FaxNumber: | 7406788139 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/02/2011 | ||||||||
| LastUpdateDate: | 08/20/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 08/20/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 04902 | CT | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 363L00000X | 14098-NP | OH | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | 0083342 | 05 | OH | MEDICAID | 3910000633 | 05 | WV | MEDICAID |