Provider Demographics
NPI:1518496710
Name:BEZOLD, LORETTA DIANE (RN)
Entity Type:Individual
Prefix:MS
First Name:LORETTA
Middle Name:DIANE
Last Name:BEZOLD
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5000
Mailing Address - Street 2:
Mailing Address - City:COUPEVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98239-5000
Mailing Address - Country:US
Mailing Address - Phone:360-678-7940
Mailing Address - Fax:360-679-7347
Practice Address - Street 1:1791 NE 1ST AVE
Practice Address - Street 2:
Practice Address - City:OAK HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98277-4301
Practice Address - Country:US
Practice Address - Phone:360-678-7940
Practice Address - Fax:360-679-7347
Is Sole Proprietor?:No
Enumeration Date:2017-06-09
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA00102711163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA00102711OtherREGISTERED NURSE