Provider Demographics
NPI:1073838959
Name:METZGER, LORI MAE
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:MAE
Last Name:METZGER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4545 E SHEA BLVD
Mailing Address - Street 2:SUITE 175
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85028-3074
Mailing Address - Country:US
Mailing Address - Phone:602-464-5200
Mailing Address - Fax:480-907-2108
Practice Address - Street 1:4545 E SHEA BLVD
Practice Address - Street 2:SUITE 175
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85028-3074
Practice Address - Country:US
Practice Address - Phone:602-464-5200
Practice Address - Fax:480-907-2108
Is Sole Proprietor?:No
Enumeration Date:2010-04-02
Last Update Date:2010-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAVP005713C363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health