Basic Information
| Provider Information | |||||||||
| NPI: | 1730200924 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LOK | ||||||||
| FirstName: | LORA | ||||||||
| MiddleName: | ANNA | ||||||||
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| Credential: | MSN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 661 JERSEY AVE | ||||||||
| Address2: | APT #3 | ||||||||
| City: | JERSEY CITY | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 073022015 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9174509099 | ||||||||
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| Practice Location | |||||||||
| Address1: | 226 DAYTON ST | ||||||||
| Address2: | |||||||||
| City: | NEWARK | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 071141159 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9736797709 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/03/2007 | ||||||||
| LastUpdateDate: | 06/22/2012 | ||||||||
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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 | F335102 | NY | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 363LP2300X | 26NJ00356000 | NJ | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Primary Care |
ID Information
| ID | Type | State | Issuer | Description | 0097845 | 05 | NJ | MEDICAID |