Provider Demographics
NPI:1609981869
Name:BELCHER, LORRIE (CRNA)
Entity type:Individual
Prefix:
First Name:LORRIE
Middle Name:
Last Name:BELCHER
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3712 BLUE JAY LN
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84121-6107
Mailing Address - Country:US
Mailing Address - Phone:801-944-0853
Mailing Address - Fax:
Practice Address - Street 1:3460 PIONEER PKWY
Practice Address - Street 2:
Practice Address - City:WEST VALLEY CITY
Practice Address - State:UT
Practice Address - Zip Code:84120-2049
Practice Address - Country:US
Practice Address - Phone:801-993-9526
Practice Address - Fax:801-733-5872
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT201014-4406367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT67306OtherPEHP
UTQM0000076439OtherALTIUS
UTTPRA08038OtherMOLINA
UT515OtherHEALTHY U
UT02980449502001OtherBCBS
UT294363OtherDESERET MUTUAL
UTQM0000076439OtherALTIUS
UTTPRA08038OtherMOLINA