Provider Demographics
NPI:1790413193
Name:MUCHOW, LORETTA LEE (NP)
Entity Type:Individual
Prefix:
First Name:LORETTA
Middle Name:LEE
Last Name:MUCHOW
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:LORETTA
Other - Middle Name:
Other - Last Name:SKELTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:100 KIMEL FOREST DR
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-6074
Mailing Address - Country:US
Mailing Address - Phone:336-716-0238
Mailing Address - Fax:
Practice Address - Street 1:MEDICAL CENTER BLVD.
Practice Address - Street 2:NEUROSURGERY
Practice Address - City:WINSTON-SALEM
Practice Address - State:NC
Practice Address - Zip Code:27157-0001
Practice Address - Country:US
Practice Address - Phone:367-164-0813
Practice Address - Fax:336-716-3065
Is Sole Proprietor?:No
Enumeration Date:2022-08-12
Last Update Date:2023-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5016673207Q00000X, 207T00000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery