Provider Demographics
NPI:1285040253
Name:FOLLETT, LOREN II
Entity Type:Individual
Prefix:MR
First Name:LOREN
Middle Name:
Last Name:FOLLETT
Suffix:II
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1055 W MOANA LN
Mailing Address - Street 2:STE. 204
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89509-4776
Mailing Address - Country:US
Mailing Address - Phone:775-825-8126
Mailing Address - Fax:775-825-8119
Practice Address - Street 1:1055 W. MOANA LN
Practice Address - Street 2:STE. 204
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89509
Practice Address - Country:US
Practice Address - Phone:775-825-8126
Practice Address - Fax:775-825-8119
Is Sole Proprietor?:No
Enumeration Date:2014-07-10
Last Update Date:2014-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV20140432699-90171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator