Provider Demographics
NPI:1083675649
Name:TEEM, LORI A (FNP)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:A
Last Name:TEEM
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 238
Mailing Address - Street 2:
Mailing Address - City:DUCHESNE
Mailing Address - State:UT
Mailing Address - Zip Code:84021-0238
Mailing Address - Country:US
Mailing Address - Phone:435-722-3971
Mailing Address - Fax:435-722-6104
Practice Address - Street 1:210 W 300 N 75-3
Practice Address - Street 2:
Practice Address - City:ROOSEVELT
Practice Address - State:UT
Practice Address - Zip Code:84066
Practice Address - Country:US
Practice Address - Phone:435-722-3971
Practice Address - Fax:435-722-6104
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-31
Last Update Date:2016-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT2159994405363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT006486034Medicare ID - Type Unspecified
UT1068670001Medicare NSC
UTP95341Medicare UPIN