Provider Demographics
NPI:1235822453
Name:STEVENS, LOREY (A-GNP-C)
Entity type:Individual
Prefix:
First Name:LOREY
Middle Name:
Last Name:STEVENS
Suffix:
Gender:F
Credentials:A-GNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 N 4TH ST
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:PA
Mailing Address - Zip Code:18013-1813
Mailing Address - Country:US
Mailing Address - Phone:610-417-7902
Mailing Address - Fax:
Practice Address - Street 1:9021 BELLA VERDE CT
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29579-5110
Practice Address - Country:US
Practice Address - Phone:843-516-2024
Practice Address - Fax:843-796-1319
Is Sole Proprietor?:No
Enumeration Date:2023-06-01
Last Update Date:2024-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP027642363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology