Provider Demographics
NPI:1659089118
Name:SLOSS, KIMLOAN
Entity Type:Individual
Prefix:
First Name:KIMLOAN
Middle Name:
Last Name:SLOSS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1415 RAVOUX LN
Mailing Address - Street 2:
Mailing Address - City:CHASKA
Mailing Address - State:MN
Mailing Address - Zip Code:55318-2526
Mailing Address - Country:US
Mailing Address - Phone:952-361-0080
Mailing Address - Fax:952-314-9613
Practice Address - Street 1:1415 RAVOUX LN
Practice Address - Street 2:
Practice Address - City:CHASKA
Practice Address - State:MN
Practice Address - Zip Code:55318-2526
Practice Address - Country:US
Practice Address - Phone:952-361-0080
Practice Address - Fax:952-314-9613
Is Sole Proprietor?:No
Enumeration Date:2022-11-14
Last Update Date:2022-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN9722363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner