Healthcare Provider Details

I. General information

NPI: 1194238345
Provider Name (Legal Business Name): LORIE JO MATTHEWS MSN,ARNP, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2017
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1675 E RIVERSIDE DR STE 200
EAGLE ID
83616-7473
US

IV. Provider business mailing address

1916 N 700 W STE 110
LAYTON UT
84041-5754
US

V. Phone/Fax

Practice location:
  • Phone: 208-785-2003
  • Fax: 208-785-9883
Mailing address:
  • Phone: 888-253-6598
  • Fax: 801-931-2263

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN002930
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: