Provider Demographics
NPI:1538305297
Name:MARINO, LORI MICHELLE (RN)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:MICHELLE
Last Name:MARINO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:LORI
Other - Middle Name:MICHELLE
Other - Last Name:LUND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:2432 VICTORIAN DR
Mailing Address - Street 2:
Mailing Address - City:RIVERTON
Mailing Address - State:UT
Mailing Address - Zip Code:84065-3102
Mailing Address - Country:US
Mailing Address - Phone:801-631-5039
Mailing Address - Fax:
Practice Address - Street 1:500 FOOTHILL DR
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84148-0001
Practice Address - Country:US
Practice Address - Phone:801-582-1565
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-31
Last Update Date:2008-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT288190-3102163W00000X
MA264157163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse