Provider Demographics
NPI:1093131468
Name:LOUK, LOREN JASON (CNP)
Entity Type:Individual
Prefix:
First Name:LOREN
Middle Name:JASON
Last Name:LOUK
Suffix:
Gender:M
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1098
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:NC
Mailing Address - Zip Code:28034-1098
Mailing Address - Country:US
Mailing Address - Phone:307-980-4913
Mailing Address - Fax:330-303-4948
Practice Address - Street 1:3768 BOARDMAN CANFIELD RD STE 5
Practice Address - Street 2:
Practice Address - City:CANFIELD
Practice Address - State:OH
Practice Address - Zip Code:44406-8502
Practice Address - Country:US
Practice Address - Phone:330-798-0491
Practice Address - Fax:330-303-4948
Is Sole Proprietor?:No
Enumeration Date:2014-03-10
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA-15708-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily