# MRS. LORI A STACKOW

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1467449835
- **Gender:** F
- **Credential:** PAC

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363A00000X | Physician Assistant | 332160 | LA | Yes |
| 363A00000X | Physician Assistant | PA10687 | TX | — |

## Other

- **Enumeration date:** 09/30/2005
- **Last updated:** 02/22/2023

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 000010017182 | REGENCE BS OF ID | ID |
| 05 | — | 004385800 | — | ID |
| 05 | — | 153449704 | — | TX |
| 01 | — | 49008 | DEPT OF LABOR AND INDUSTR | WA |
| 01 | — | 601417200 | DEEIOC | — |
| 05 | — | 8434896 | — | WA |
| 01 | — | PAJB6 | BLUE CROSS OF ID | ID |