Provider Demographics
NPI:1891459855
Name:STANDISH, LORAL JEANNE (FNP-C)
Entity Type:Individual
Prefix:
First Name:LORAL
Middle Name:JEANNE
Last Name:STANDISH
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44685 ASHBURY PL
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92592-5848
Mailing Address - Country:US
Mailing Address - Phone:951-595-5300
Mailing Address - Fax:
Practice Address - Street 1:44685 ASHBURY PL
Practice Address - Street 2:
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92592-5848
Practice Address - Country:US
Practice Address - Phone:951-595-5300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-26
Last Update Date:2021-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95018810363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily