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Individual
LORI ELLIS
Active
Individual
LORI ELLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
280026
LA
246RM2200X
Medical Laboratory Technician
Primary
—
NULL
331L00000X
Blood Bank
—
NULL
Other
Enumeration date
12/02/2020
Last updated
11/20/2021
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