Provider Demographics
NPI:1669924171
Name:LOE, LOUISE
Entity type:Individual
Prefix:
First Name:LOUISE
Middle Name:
Last Name:LOE
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 1:530 HOWARD CT UNIT B
Mailing Address - Street 2:
Mailing Address - City:SUSANVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:96130-3190
Mailing Address - Country:US
Mailing Address - Phone:252-412-4015
Mailing Address - Fax:707-264-6510
Practice Address - Street 1:530 HOWARD CT UNIT B
Practice Address - Street 2:
Practice Address - City:SUSANVILLE
Practice Address - State:CA
Practice Address - Zip Code:96130-3190
Practice Address - Country:US
Practice Address - Phone:252-412-4015
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-31
Last Update Date:2025-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9005754207Q00000X
CAF1016188363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF1016188Medicare UPIN