Provider Demographics
NPI:1114224854
Name:BASS, LOREN (CRNP)
Entity Type:Individual
Prefix:MRS
First Name:LOREN
Middle Name:
Last Name:BASS
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:395 NORTHWOOD DR
Mailing Address - Street 2:
Mailing Address - City:CENTRE
Mailing Address - State:AL
Mailing Address - Zip Code:35960-1045
Mailing Address - Country:US
Mailing Address - Phone:256-927-4900
Mailing Address - Fax:256-927-9151
Practice Address - Street 1:395 NORTHWOOD DR
Practice Address - Street 2:
Practice Address - City:CENTRE
Practice Address - State:AL
Practice Address - Zip Code:35960-1045
Practice Address - Country:US
Practice Address - Phone:256-927-4900
Practice Address - Fax:256-927-9151
Is Sole Proprietor?:No
Enumeration Date:2011-02-15
Last Update Date:2021-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-107686163W00000X
ALF0211066363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse