Provider Demographics
NPI:1386730851
Name:NIEDEREE, LAURIE A (MD)
Entity type:Individual
Prefix:
First Name:LAURIE
Middle Name:A
Last Name:NIEDEREE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3340 NORTH CENTER ST
Mailing Address - Street 2:#800
Mailing Address - City:LEHI
Mailing Address - State:UT
Mailing Address - Zip Code:84043-7406
Mailing Address - Country:US
Mailing Address - Phone:801-990-1911
Mailing Address - Fax:801-990-1912
Practice Address - Street 1:9660 SOUTH 1300 EAST
Practice Address - Street 2:ALTA VIEW HOSPITAL
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84094
Practice Address - Country:US
Practice Address - Phone:801-501-2600
Practice Address - Fax:801-733-5618
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2012-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT181273-1205207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY118915800Medicaid
AZ822462Medicaid
UTTPRA07467OtherMOLINA
UT73541OtherPEHP
ID806732900Medicaid
UTQM0000075886OtherALTIUS
UT2090168OtherUNITED HEALTHCARE
UT870545614LN2OtherEDUCATORS MUTUAL
UT9754OtherHEALTHY U
UT107006952102OtherIHC
NV100501271Medicaid
UT1502954OtherUMWA
UT264745OtherDESERET MUTUAL
UT107006952102OtherIHC
NV100501271Medicaid
UT005532798Medicare ID - Type Unspecified