Provider Demographics
NPI:1831694769
Name:MYERS-WEBER, LORETTA (NP-C)
Entity type:Individual
Prefix:
First Name:LORETTA
Middle Name:
Last Name:MYERS-WEBER
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4672 LAKEWOOD ST
Mailing Address - Street 2:
Mailing Address - City:PLEASANTON
Mailing Address - State:CA
Mailing Address - Zip Code:94588-4343
Mailing Address - Country:US
Mailing Address - Phone:925-577-8926
Mailing Address - Fax:
Practice Address - Street 1:1510 FLORIDA AVE STE A
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95350
Practice Address - Country:US
Practice Address - Phone:209-492-7150
Practice Address - Fax:209-492-7119
Is Sole Proprietor?:No
Enumeration Date:2018-03-23
Last Update Date:2018-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95008380363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily