Provider Demographics
NPI:1154315521
Name:LEE, LORIE (PA-C)
Entity Type:Individual
Prefix:
First Name:LORIE
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5848 FASHION BLVD
Mailing Address - Street 2:
Mailing Address - City:MURRAY
Mailing Address - State:UT
Mailing Address - Zip Code:84107-6121
Mailing Address - Country:US
Mailing Address - Phone:801-314-4329
Mailing Address - Fax:801-314-4919
Practice Address - Street 1:5848 FASHION BLVD
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84107-6121
Practice Address - Country:US
Practice Address - Phone:801-314-4329
Practice Address - Fax:801-314-4919
Is Sole Proprietor?:No
Enumeration Date:2005-08-31
Last Update Date:2008-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5916955-1206363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTS90749Medicare UPIN
UT005736213Medicare PIN