Provider Demographics
NPI:1538327747
Name:LOOS, SCOTT A (LPN)
Entity Type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:A
Last Name:LOOS
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 W 2ND ST
Mailing Address - Street 2:APT. 8
Mailing Address - City:PANA
Mailing Address - State:IL
Mailing Address - Zip Code:62557-1364
Mailing Address - Country:US
Mailing Address - Phone:217-562-7202
Mailing Address - Fax:
Practice Address - Street 1:111 W 2ND ST
Practice Address - Street 2:APT. 8
Practice Address - City:PANA
Practice Address - State:IL
Practice Address - Zip Code:62557-1364
Practice Address - Country:US
Practice Address - Phone:217-562-7202
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-26
Last Update Date:2008-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant