Healthcare Provider Details

I. General information

NPI: 1356745103
Provider Name (Legal Business Name): LORI ANN SOTEROS F.N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/22/2014
Last Update Date: 10/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

727 E BETHANY HOME RD SUITE A-101
PHOENIX AZ
85014-2198
US

IV. Provider business mailing address

PO BOX 11070
CASA GRANDE AZ
85130-0138
US

V. Phone/Fax

Practice location:
  • Phone: 602-279-2400
  • Fax: 602-279-5890
Mailing address:
  • Phone: 563-343-7425
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP7491
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: