Provider Demographics
NPI:1760467625
Name:PARKER, LORI ANN (NP C)
Entity Type:Individual
Prefix:MRS
First Name:LORI
Middle Name:ANN
Last Name:PARKER
Suffix:
Gender:F
Credentials:NP C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4218 E 400 N
Mailing Address - Street 2:
Mailing Address - City:RIGBY
Mailing Address - State:ID
Mailing Address - Zip Code:83442-5523
Mailing Address - Country:US
Mailing Address - Phone:208-745-5215
Mailing Address - Fax:
Practice Address - Street 1:SHC 100
Practice Address - Street 2:BYU IDAHO
Practice Address - City:REXBURG
Practice Address - State:ID
Practice Address - Zip Code:83460-2010
Practice Address - Country:US
Practice Address - Phone:208-496-1300
Practice Address - Fax:208-496-1306
Is Sole Proprietor?:No
Enumeration Date:2005-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDNP 660A363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner