Stackow, Lori A
Stackow, Lori A is an individual health care provider with primary practice located at 1541 Kings Hwy , Shreveport LA 71103-4228. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant, which is considered as her primary health care specialty. Stackow, Lori A can be contacted via phone (318) 626-0000.Contact Information
Primary practice address
1541 Kings Hwy
Shreveport LA 71103-4228
Phone: (318) 626-0000
Fax: (318) 629-4833
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant | 363A00000X | PA10687 | Texas |
| Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant | 363A00000X | 332160 | Louisiana |
Profile Details
| NPI number | 1467449835 |
|---|---|
| LBN Legal business name | Stackow, Lori A |
| Credentials | PAC |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Sep 30th, 2005 |
| Last updated | Feb 22nd, 2023 - about 2 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1467449835 | NPPES |
| Washington | Other | 49008 | DEPT OF LABOR AND INDUSTR |
| Washington | MEDICAID | 8434896 | DEPT OF LABOR AND INDUSTR |
| Washington | MEDICAID | 004385800 | DEPT OF LABOR AND INDUSTR |
| Washington | MEDICAID | 153449704 | DEPT OF LABOR AND INDUSTR |
| Washington | Other | PAJB6 | DEPT OF LABOR AND INDUSTR |
| Washington | Other | 000010017182 | DEPT OF LABOR AND INDUSTR |
| Washington | Other | 601417200 | DEPT OF LABOR AND INDUSTR |
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