Provider Demographics
NPI:1396934006
Name:LOYA, MICHELLE B (CRNA)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:B
Last Name:LOYA
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46 W GUDE DR
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-1150
Mailing Address - Country:US
Mailing Address - Phone:301-424-6901
Mailing Address - Fax:
Practice Address - Street 1:46 W GUDE DR
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-1150
Practice Address - Country:US
Practice Address - Phone:301-424-6901
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-18
Last Update Date:2014-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR072824163WM0705X
MD38006367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD401025600Medicaid
DCS417-0024OtherCAREFIRST BCBS
MDKBC1CHOtherCAREFIRST BCBS
DCS417-0024OtherCAREFIRST BCBS