Provider Demographics
NPI:1881941383
Name:OMYIA LOEDUM, JOYCE (LVN)
Entity type:Individual
Prefix:
First Name:JOYCE
Middle Name:
Last Name:OMYIA LOEDUM
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1330 MAC ARTHUR DR
Mailing Address - Street 2:#2719
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75007-4464
Mailing Address - Country:US
Mailing Address - Phone:972-201-4968
Mailing Address - Fax:
Practice Address - Street 1:1330 MAC ARTHUR DR
Practice Address - Street 2:#2719
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75007-4464
Practice Address - Country:US
Practice Address - Phone:972-201-4968
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-14
Last Update Date:2012-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA225528164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse