Provider Demographics
NPI:1407858616
Name:LOEWEN, ANALISA MIRANDA (NP)
Entity Type:Individual
Prefix:
First Name:ANALISA
Middle Name:MIRANDA
Last Name:LOEWEN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:ANALISA
Other - Middle Name:M
Other - Last Name:THIEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:10 ADAK CT
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94597-2424
Mailing Address - Country:US
Mailing Address - Phone:812-449-1647
Mailing Address - Fax:
Practice Address - Street 1:2311 LOVERIDGE RD
Practice Address - Street 2:
Practice Address - City:PITTSBURG
Practice Address - State:CA
Practice Address - Zip Code:94565-5117
Practice Address - Country:US
Practice Address - Phone:925-431-2300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-01
Last Update Date:2013-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71001470A363L00000X
CA21486363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000343152OtherBCBS PIN
IN000000485492OtherANTHEM PIN - MARY ST
IN000000485495OtherANTHEM PIN - GATEWAY BLVD
IN200489350Medicaid
IN182780NMedicare ID - Type Unspecified
IN200489350Medicaid
IN534980KKKMedicare PIN
INP00205381Medicare PIN