Provider Demographics
NPI:1750905758
Name:PACHECO, LONI RAE (NP-BC)
Entity type:Individual
Prefix:
First Name:LONI
Middle Name:RAE
Last Name:PACHECO
Suffix:
Gender:F
Credentials:NP-BC
Other - Prefix:
Other - First Name:LONI
Other - Middle Name:RAE
Other - Last Name:HOFMANN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:42350 GRAND RIVER AVE
Mailing Address - Street 2:
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48375-1838
Mailing Address - Country:US
Mailing Address - Phone:248-697-2942
Mailing Address - Fax:248-436-6628
Practice Address - Street 1:42350 GRAND RIVER AVE
Practice Address - Street 2:
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48375-1838
Practice Address - Country:US
Practice Address - Phone:248-697-2942
Practice Address - Fax:248-436-6628
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-04
Last Update Date:2022-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704300580363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care