Provider Demographics
NPI:1790096089
Name:LOEHR, JORDANN
Entity type:Individual
Prefix:
First Name:JORDANN
Middle Name:
Last Name:LOEHR
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 68
Mailing Address - Street 2:
Mailing Address - City:ZILLAH
Mailing Address - State:WA
Mailing Address - Zip Code:98953-0068
Mailing Address - Country:US
Mailing Address - Phone:509-495-1954
Mailing Address - Fax:480-781-4956
Practice Address - Street 1:618 RAILROAD AVE
Practice Address - Street 2:
Practice Address - City:ZILLAH
Practice Address - State:WA
Practice Address - Zip Code:98953-9426
Practice Address - Country:US
Practice Address - Phone:509-495-1954
Practice Address - Fax:480-781-4956
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-01
Last Update Date:2025-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD60778018207V00000X
CAA131479207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACA129456Medicare PIN