Provider Demographics
NPI:1730489402
Name:LOEB, CAROL JOY (RN)
Entity Type:Individual
Prefix:MS
First Name:CAROL
Middle Name:JOY
Last Name:LOEB
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9509 WHITE SPRING WAY
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21046-2063
Mailing Address - Country:US
Mailing Address - Phone:410-792-7503
Mailing Address - Fax:
Practice Address - Street 1:4620 WOODLAND RD
Practice Address - Street 2:
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21042-6329
Practice Address - Country:US
Practice Address - Phone:410-707-3929
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-28
Last Update Date:2010-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR079106163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse