Provider Demographics
NPI:1326081720
Name:CHENEY, LORI A (APN)
Entity Type:Individual
Prefix:MS
First Name:LORI
Middle Name:A
Last Name:CHENEY
Suffix:
Gender:F
Credentials:APN
Other - Prefix:MS
Other - First Name:LORI
Other - Middle Name:A
Other - Last Name:GRONQUIST
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:500 N US HIGHWAY 89
Mailing Address - Street 2:NORTHERN ARIZONA VA HCS (NAVAHCS)
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86313
Mailing Address - Country:US
Mailing Address - Phone:928-445-4860
Mailing Address - Fax:928-680-0430
Practice Address - Street 1:500 N US HIGHWAY 89
Practice Address - Street 2:NORTHERN ARIZONA VA HCS (NAVAHCS)
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86313
Practice Address - Country:US
Practice Address - Phone:928-445-4860
Practice Address - Fax:928-680-0430
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2015-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP2298363LF0000X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ991936Medicaid
AZZ106737Medicare PIN
AZ991936Medicaid