Provider Demographics
NPI:1932845294
Name:LORET, AMY DEE (MD)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:DEE
Last Name:LORET
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 1:1232 RIDGE MEADOW LN APT 3E
Mailing Address - Street 2:
Mailing Address - City:COTTONWOOD HEIGHTS
Mailing Address - State:UT
Mailing Address - Zip Code:84047-6200
Mailing Address - Country:US
Mailing Address - Phone:801-884-8892
Mailing Address - Fax:
Practice Address - Street 1:6506 OKLAHOMA ST SE
Practice Address - Street 2:
Practice Address - City:LACEY
Practice Address - State:WA
Practice Address - Zip Code:98513-5088
Practice Address - Country:US
Practice Address - Phone:801-884-8892
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-10
Last Update Date:2024-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61549329207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine