Individual
LORI A. CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
801 OSTRUM ST, BETHLEHEM, PA 18015-1000
(610) 954-5810
(610) 954-5480
Mailing address
PO BOX 5520, BETHLEHEM, PA 18015-0520
(610) 954-5810
(610) 954-5480
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
RN-507355-L
PA
367500000X
Certified Registered Nurse Anesthetist
Primary
076891
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1027796550001
—
PA
01
—
104166
GEISINGER
PA
01
—
11802986
CAQH
PA
01
—
1580856
GATEWAY
PA
01
—
1924485
FIRST PRIORITY
PA
01
—
2792759000
IBC
PA
01
—
50065227
CAPITAL ADVANTAGE
PA
01
—
9696443
AETNA
PA
Enumeration date
12/06/2006
Last updated
10/12/2022
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