Provider Demographics
NPI:1720225279
Name:LOUKOLA, JIM NESTER
Entity Type:Individual
Prefix:MR
First Name:JIM
Middle Name:NESTER
Last Name:LOUKOLA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:440 N WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86301-2642
Mailing Address - Country:US
Mailing Address - Phone:928-443-1991
Mailing Address - Fax:
Practice Address - Street 1:20216 E. CONESTOGAO DR.
Practice Address - Street 2:
Practice Address - City:MAYER
Practice Address - State:AZ
Practice Address - Zip Code:86333
Practice Address - Country:US
Practice Address - Phone:928-638-9192
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-20
Last Update Date:2009-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ900145174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist