Provider Demographics
NPI:1225660723
Name:LOSTON, NEBRA KANIVBREYA
Entity Type:Individual
Prefix:
First Name:NEBRA
Middle Name:KANIVBREYA
Last Name:LOSTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 A B MARTIN RD
Mailing Address - Street 2:
Mailing Address - City:JEANERETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70544-8701
Mailing Address - Country:US
Mailing Address - Phone:337-579-0971
Mailing Address - Fax:
Practice Address - Street 1:100 A B MARTIN RD
Practice Address - Street 2:
Practice Address - City:JEANERETTE
Practice Address - State:LA
Practice Address - Zip Code:70544-8701
Practice Address - Country:US
Practice Address - Phone:337-579-0971
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-12
Last Update Date:2020-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator