Healthcare Provider Details

I. General information

NPI: 1073712782
Provider Name (Legal Business Name): JONATHAN M LOETSCHER CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2007
Last Update Date: 06/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 W 40TH AVE SUITE 2B
PINE BLUFF AR
71603-6940
US

IV. Provider business mailing address

1801 W 40TH AVE SUITE 2B
PINE BLUFF AR
71603-6940
US

V. Phone/Fax

Practice location:
  • Phone: 870-535-7457
  • Fax: 870-535-2522
Mailing address:
  • Phone: 870-535-7457
  • Fax: 870-535-2522

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberC02665
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: