Healthcare Provider Details

I. General information

NPI: 1851327886
Provider Name (Legal Business Name): SHANNON DAY LOREE NP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/23/2006
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8549 N UNIVERSITY AVENUE STE 200 SP 4 SUITE 202
PROVO UT
84604-3305
US

IV. Provider business mailing address

3549 N UNIVERSITY AVE STE 200
PROVO UT
84604-4417
US

V. Phone/Fax

Practice location:
  • Phone: 801-374-2367
  • Fax: 801-429-8015
Mailing address:
  • Phone: 801-882-4500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number7483839-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: