Provider Demographics
NPI:1356745103
Name:SOTEROS, LORI ANN (FNP)
Entity type:Individual
Prefix:MRS
First Name:LORI
Middle Name:ANN
Last Name:SOTEROS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 11070
Mailing Address - Street 2:
Mailing Address - City:CASA GRANDE
Mailing Address - State:AZ
Mailing Address - Zip Code:85130-0138
Mailing Address - Country:US
Mailing Address - Phone:563-343-7425
Mailing Address - Fax:
Practice Address - Street 1:727 E BETHANY HOME RD
Practice Address - Street 2:SUITE A-101
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85014-2198
Practice Address - Country:US
Practice Address - Phone:602-279-2400
Practice Address - Fax:602-279-5890
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-22
Last Update Date:2015-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP7491363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ062797Medicaid