Provider Demographics
NPI:1316410657
Name:VECCHIONE, LORIE MAE GADAINGAN
Entity Type:Individual
Prefix:
First Name:LORIE MAE
Middle Name:GADAINGAN
Last Name:VECCHIONE
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 1:80 CABRILLO HWY N STE Q
Mailing Address - Street 2:
Mailing Address - City:HALF MOON BAY
Mailing Address - State:CA
Mailing Address - Zip Code:94019-1698
Mailing Address - Country:US
Mailing Address - Phone:510-239-9122
Mailing Address - Fax:
Practice Address - Street 1:1 JOHNSON PIER
Practice Address - Street 2:
Practice Address - City:HALF MOON BAY
Practice Address - State:CA
Practice Address - Zip Code:94019-4000
Practice Address - Country:US
Practice Address - Phone:510-239-9122
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-09
Last Update Date:2022-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP95010689363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CANPF95010689OtherNURSE PRACTITIONER FURNISHING NUMBER