Provider Demographics
NPI:1073628251
Name:STARR, LOREN LLOYD (CRNA)
Entity Type:Individual
Prefix:MR
First Name:LOREN
Middle Name:LLOYD
Last Name:STARR
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:MR
Other - First Name:LOREN
Other - Middle Name:LLOYD
Other - Last Name:STARR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CRNA
Mailing Address - Street 1:13241 WOLLWEBER RD N
Mailing Address - Street 2:
Mailing Address - City:EDWALL
Mailing Address - State:WA
Mailing Address - Zip Code:99008-9562
Mailing Address - Country:US
Mailing Address - Phone:231-679-0634
Mailing Address - Fax:
Practice Address - Street 1:3143 E 29TH AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99223
Practice Address - Country:US
Practice Address - Phone:231-679-0634
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-20
Last Update Date:2010-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI3745593367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIRO9000Medicare UPIN