Provider Demographics
NPI:1295212199
Name:LOSEKE, RYAN (SOIDC, EMT-P)
Entity Type:Individual
Prefix:MR
First Name:RYAN
Middle Name:
Last Name:LOSEKE
Suffix:
Gender:M
Credentials:SOIDC, EMT-P
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3D MRB
Mailing Address - Street 2:
Mailing Address - City:CAMP LEJEUNE
Mailing Address - State:NC
Mailing Address - Zip Code:28460
Mailing Address - Country:US
Mailing Address - Phone:314-566-1976
Mailing Address - Fax:314-566-1976
Practice Address - Street 1:3D MRB
Practice Address - Street 2:
Practice Address - City:CAMP LEJEUNE
Practice Address - State:NC
Practice Address - Zip Code:28460
Practice Address - Country:US
Practice Address - Phone:314-566-1976
Practice Address - Fax:314-566-1976
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-24
Last Update Date:2018-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman