Provider Demographics
NPI:1891455747
Name:LOYA, MARISA
Entity Type:Individual
Prefix:
First Name:MARISA
Middle Name:
Last Name:LOYA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:636 SILVER MOSS DR
Mailing Address - Street 2:
Mailing Address - City:MONCKS CORNER
Mailing Address - State:SC
Mailing Address - Zip Code:29461-7468
Mailing Address - Country:US
Mailing Address - Phone:913-259-9724
Mailing Address - Fax:
Practice Address - Street 1:636 SILVER MOSS DR
Practice Address - Street 2:
Practice Address - City:MONCKS CORNER
Practice Address - State:SC
Practice Address - Zip Code:29461-7468
Practice Address - Country:US
Practice Address - Phone:913-259-9724
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-20
Last Update Date:2021-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC263299163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse