Provider Demographics
NPI:1861037624
Name:MAYER, LORETTA LEE (DNP, NP-C, APRN, RN)
Entity Type:Individual
Prefix:DR
First Name:LORETTA
Middle Name:LEE
Last Name:MAYER
Suffix:
Gender:F
Credentials:DNP, NP-C, APRN, RN
Other - Prefix:
Other - First Name:LORETTA
Other - Middle Name:LEE
Other - Last Name:MAYER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:16040 PARK VALLEY DR # B-100
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78681-3578
Mailing Address - Country:US
Mailing Address - Phone:512-218-1222
Mailing Address - Fax:512-341-0425
Practice Address - Street 1:16040 PARK VALLEY DR # B-100
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78681-3578
Practice Address - Country:US
Practice Address - Phone:512-218-1222
Practice Address - Fax:512-341-0425
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-15
Last Update Date:2019-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP142697363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily