Provider Demographics
NPI:1184967887
Name:LOEBER, MICHELLE M (APRN)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:M
Last Name:LOEBER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2121 S COLUMBIA AVE
Mailing Address - Street 2:STE 501
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74114-3513
Mailing Address - Country:US
Mailing Address - Phone:918-615-4015
Mailing Address - Fax:
Practice Address - Street 1:2121 S COLUMBIA AVE STE 501
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74114-3513
Practice Address - Country:US
Practice Address - Phone:918-615-4015
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-01
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK82695363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner