Provider Demographics
NPI:1528381308
Name:LOYOLA, TERESA MARIE (LPN)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:MARIE
Last Name:LOYOLA
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:TERREE
Other - Middle Name:MARIE
Other - Last Name:LOYOLA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPN
Mailing Address - Street 1:9005 W MULBERRY DR
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85037-2945
Mailing Address - Country:US
Mailing Address - Phone:602-573-0435
Mailing Address - Fax:
Practice Address - Street 1:9040 W CAMPBELL AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85037-1408
Practice Address - Country:US
Practice Address - Phone:623-772-2709
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-08
Last Update Date:2010-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLP044800164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse