Individual
LORI A BAZEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
3035 DEMERS AVE, GRAND FORKS, ND 58201-4040
(701) 775-3151
Mailing address
3366 DESERT STAR LN, GRAND FORKS, ND 58201-5823
(701) 746-7441
(701) 746-7447
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
R22456
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
010M8BA
BCBS
MN
01
—
021269
BCBS
ND
05
—
11931
—
ND
01
—
430010862
RR MEDICARE
—
05
—
661345400
—
MN
Enumeration date
08/23/2006
Last updated
04/23/2008
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