Provider Demographics
NPI:1225796451
Name:STAPLETON, CORRIE LAMOREAUX (NP)
Entity Type:Individual
Prefix:
First Name:CORRIE
Middle Name:LAMOREAUX
Last Name:STAPLETON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1112 E 300 N STE 202
Mailing Address - Street 2:
Mailing Address - City:AMERICAN FORK
Mailing Address - State:UT
Mailing Address - Zip Code:84003-2484
Mailing Address - Country:US
Mailing Address - Phone:801-577-7055
Mailing Address - Fax:888-717-7578
Practice Address - Street 1:1112 E 300 N STE 202
Practice Address - Street 2:
Practice Address - City:AMERICAN FORK
Practice Address - State:UT
Practice Address - Zip Code:84003-2484
Practice Address - Country:US
Practice Address - Phone:801-577-7055
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-05
Last Update Date:2023-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10832313-4405363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT10832313-8900OtherAPRN CONTROLLED SUBSTANCE SCHEDULE 2-5 LICENSE
UT10832313-4405OtherSTATE APRN LICENSE