Provider Demographics
NPI:1851327886
Name:LOREE, SHANNON DAY (NP)
Entity Type:Individual
Prefix:MR
First Name:SHANNON
Middle Name:DAY
Last Name:LOREE
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1055 N 500 W
Mailing Address - Street 2:
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84604-3305
Mailing Address - Country:US
Mailing Address - Phone:801-429-8000
Mailing Address - Fax:
Practice Address - Street 1:1055 N 500 W
Practice Address - Street 2:SUITE 202
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84604-3305
Practice Address - Country:US
Practice Address - Phone:801-374-2367
Practice Address - Fax:801-429-8015
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2011-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP15320363L00000X
UT7483839-4405363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q67981Medicare UPIN