Organization
LORENA CANNON LLC
Active
Other names
Peachtree Medical Clinic, Peachtree Medical Care, LLC
Organization subpart
No
Provider details
NPI number
Authorized official
LORENA CANNON APRN (OWNER / PROVIDER)
(208) 351-5458
Entity
Organization
Contact information
Practice address
893 E 9400 S, SANDY, UT 84094-3671
(385) 335-7862
Mailing address
893 E 9400 S, SANDY, UT 84094-3671
(385) 335-7862
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
—
363L00000X
Nurse Practitioner
—
—
Other
Enumeration date
02/04/2021
Last updated
03/08/2021
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