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Lori A Niland

Physician Assistant

Physician Assistants & Advanced Practice Nursing Providers

PECOS Enrollment

Based on the most recent information from CMS, provider Lori A Niland does not have current enrollment records in PECOS.

Part B
Medicare Part B
Not Enrolled
HHA
Home Health Agency
Not Enrolled
DME
Durable Medical Equipment
Not Enrolled
PMD
Power Mobility Device
Not Enrolled

CMS last updated its PECOS records yesterday at 2:35 PM.

Profile Details

Provider ID
1003893108
Provider Type
Individual
Full Name
Niland, Lori A
Title
Ms.
Credential
PA-C

Gender
Female
Sole Proprietor
No
Enumeration Date
12/29/2005
Last Updated
1/8/2015

Contact Information

Practice Location

22 Bramhall Street, Portland, ME 04102

(207) 662-2934

(207) 662-6389

Mailing Location

PO Box 16023, Lewiston, ME 04243-9503

(207) 396-8600

(603) 692-6040

Provider Taxonomies

Code	Description	License
Code 363A00000X Primary	Description Physician Assistant Physician Assistants & Advanced Practice Nursing Providers	License PA620 Maine
Code 363A00000X	Description Physician Assistant Physician Assistants & Advanced Practice Nursing Providers	License PA-620 Maine
Code 363A00000X	Description Physician Assistant Physician Assistants & Advanced Practice Nursing Providers	License 0859 New Hampshire

Provider Identifiers

ID	Description	Issuer
ID 3071700	Description Medicaid	Issuer Unlisted New Hampshire
ID P01038297	Description Other	Issuer RAILROAD MEDICARE New Hampshire
ID 30332527	Description Medicaid	Issuer Unlisted New Hampshire

Lori A Niland

PECOS Enrollment

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