Provider Demographics
NPI:1851555825
Name:LOOMIS, KAYCEE DOREEN I (LVN)
Entity Type:Individual
Prefix:MRS
First Name:KAYCEE
Middle Name:DOREEN
Last Name:LOOMIS
Suffix:I
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13643 HEMINGWAY DR
Mailing Address - Street 2:
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92392-8311
Mailing Address - Country:US
Mailing Address - Phone:760-955-7010
Mailing Address - Fax:
Practice Address - Street 1:13643 HEMINGWAY DR
Practice Address - Street 2:
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92392-8311
Practice Address - Country:US
Practice Address - Phone:760-955-7010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-17
Last Update Date:2008-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN202716164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse