Provider Demographics
NPI:1720286875
Name:KLASKI, LORI A (PA-C)
Entity type:Individual
Prefix:MRS
First Name:LORI
Middle Name:A
Last Name:KLASKI
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:LORI
Other - Middle Name:
Other - Last Name:KOCHERSPERGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:25830 N 108TH AVE
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85383-9800
Mailing Address - Country:US
Mailing Address - Phone:602-615-8030
Mailing Address - Fax:602-584-6202
Practice Address - Street 1:5859 W TALAVI BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85306-1869
Practice Address - Country:US
Practice Address - Phone:602-298-7777
Practice Address - Fax:623-930-6060
Is Sole Proprietor?:No
Enumeration Date:2007-07-10
Last Update Date:2021-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3620363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ3620OtherLICENSE
AZ234159Medicaid