Provider Demographics
NPI:1710728696
Name:LOREI, MADELYN E (PA-C)
Entity type:Individual
Prefix:
First Name:MADELYN
Middle Name:E
Last Name:LOREI
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4613 JARBOE ST
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64112-1218
Mailing Address - Country:US
Mailing Address - Phone:816-699-6367
Mailing Address - Fax:
Practice Address - Street 1:4613 JARBOE ST
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64112-1218
Practice Address - Country:US
Practice Address - Phone:816-699-6367
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-04
Last Update Date:2024-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085010221363A00000X
MO2024011261363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant