1336614858 NPI number — MS. TERESA LOERA FNP-C

Table of content: MS. TERESA LOERA FNP-C (NPI 1336614858)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336614858 NPI number — MS. TERESA LOERA FNP-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LOERA
Provider First Name:
TERESA
Provider Middle Name:
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
FNP-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1336614858
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/31/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3201 W PEORIA AVE
Provider Second Line Business Mailing Address:
A105
Provider Business Mailing Address City Name:
PHOENIX
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85029-4069
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
602-918-3225
Provider Business Mailing Address Fax Number:
833-992-2059

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3201 W PEORIA AVE
Provider Second Line Business Practice Location Address:
A105
Provider Business Practice Location Address City Name:
PHOENIX
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85029-4609
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
602-918-3225
Provider Business Practice Location Address Fax Number:
833-992-2059
Provider Enumeration Date:
10/11/2018

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 163W00000X , with the licence number:  RN157495 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X , with the licence number: AP11478 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 545062 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: AP11478 . This is a "CERTIFIED NURSE PRACTITIONER" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: F06182018 . This is a "AMERICAN ACADEMY OF NURSE PRACTITIONERS" identifier . This identifiers is of the category "OTHER".




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