Provider Demographics
NPI:1598776726
Name:PRESTON, LORETTA (CRNP)
Entity Type:Individual
Prefix:
First Name:LORETTA
Middle Name:
Last Name:PRESTON
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1526 5TH AVE S
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35233-1615
Mailing Address - Country:US
Mailing Address - Phone:205-279-2860
Mailing Address - Fax:205-252-0197
Practice Address - Street 1:1515 6TH AVE S
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35233-1601
Practice Address - Country:US
Practice Address - Phone:205-279-2860
Practice Address - Fax:205-255-2019
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2011-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1046690363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009960255Medicaid
AL051524381OtherBCBS OF AL
AL009960235Medicaid
AL051522774OtherBCBS OF AL
AL051522775OtherBCBS OF AL
AL051522770OtherBCBS OF AL
AL051522773OtherBCBS OF AL
AL009960245Medicaid
AL009960285Medicaid
AL051522768OtherBCBS OF AL
AL051524382OtherBCBS OF AL
AL891009170Medicaid
AL009958435Medicaid
AL009960275Medicaid
AL009973855Medicaid
AL051522769OtherBCBS OF AL
AL051522771OtherBCBS OF AL
AL891009160Medicaid
AL009960265Medicaid
AL009960285Medicaid