1922406131 NPI number — JACQUELINE ELIZABETH LOESCH RDH

Table of content: JACQUELINE ELIZABETH LOESCH RDH (NPI 1922406131)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922406131 NPI number — JACQUELINE ELIZABETH LOESCH RDH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LOESCH
Provider First Name:
JACQUELINE
Provider Middle Name:
ELIZABETH
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
RDH
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
PIRTLE
Provider Other First Name:
JACQUELINE
Provider Other Middle Name:
ELIZABETH
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1922406131
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/02/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4041 E SAN MIGUEL ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COLORADO SPRINGS
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80909-3537
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
719-632-5700
Provider Business Mailing Address Fax Number:
719-344-7880

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4041 E SAN MIGUEL ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COLORADO SPRINGS
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80909-3537
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
719-632-5700
Provider Business Practice Location Address Fax Number:
719-344-7880
Provider Enumeration Date:
12/22/2014

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: 124Q00000X , with the licence number:  DH.002023951 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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