Healthcare Provider Details

I. General information

NPI: 1073838959
Provider Name (Legal Business Name): LORI MAE METZGER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2010
Last Update Date: 04/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4545 E SHEA BLVD SUITE 175
PHOENIX AZ
85028-3074
US

IV. Provider business mailing address

4545 E SHEA BLVD SUITE 175
PHOENIX AZ
85028-3074
US

V. Phone/Fax

Practice location:
  • Phone: 602-464-5200
  • Fax: 480-907-2108
Mailing address:
  • Phone: 602-464-5200
  • Fax: 480-907-2108

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberVP005713C
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: