Healthcare Provider Details

I. General information

NPI: 1649868076
Provider Name (Legal Business Name): JESSICA LYNN LOOMIS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/31/2020
Last Update Date: 03/28/2023
Certification Date: 03/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4755 OGLETOWN STANTON RD
NEWARK DE
19718-2200
US

IV. Provider business mailing address

505 RIDGELY BLVD
DOVER DE
19904-4008
US

V. Phone/Fax

Practice location:
  • Phone: 302-733-1000
  • Fax:
Mailing address:
  • Phone: 302-233-3871
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberLG-0011515
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: