Lori Virginia Deatherage, LPN

Primary specialty

Licensed Practical NurseTaxonomy code 164W00000X

License

PN.0026443 Issued in CO

Practice address

212 W 13TH St
Pueblo, CO 81003-3754

Phone

(719) 696-9027

NPI assigned

Oct 24, 2024

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1729728000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1729728000000",
    "number": "1548081235",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "212 W 13TH ST",
            "city": "PUEBLO",
            "state": "CO",
            "postal_code": "810033754",
            "telephone_number": "719-696-9027"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "212 W 13TH ST",
            "city": "PUEBLO",
            "state": "CO",
            "postal_code": "810033754",
            "telephone_number": "719-696-9027"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEATHERAGE",
        "first_name": "LORI",
        "middle_name": "VIRGINIA",
        "credential": "LPN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-10-24",
        "last_updated": "2024-10-24",
        "certification_date": "2024-10-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "CO",
            "license": "PN.0026443",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Edna Aguila De la Cruz, MSN, PMHNP-BC, FNP-C
• Daniela Monique De Vargas Boyer, D.O.
• John De Villa, FNP-BC
• Jacquelyn De'Anda, LSW, SWC, MSW
• Jayda De'Anda
• Deborah L Schmuckal LCSW LLC
• Jacqueline L Decarlo, OTR/L
• Tonya Loree Decarlo, PTA
• Alisa A Decesaro, MOT, OTR/L
• Daniel Leon Decock

• Licensed Practical Nurse in Pueblo, CO
• Providers in Pueblo, CO by specialty
• Licensed Practical Nurse in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 24, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.