Healthcare Provider Details

I. General information

NPI: 1093131468
Provider Name (Legal Business Name): LOREN JASON LOUK CNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/10/2014
Last Update Date: 07/08/2025
Certification Date: 07/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3768 BOARDMAN CANFIELD RD STE 5
CANFIELD OH
44406-8502
US

IV. Provider business mailing address

PO BOX 3702
BOARDMAN OH
44513-3702
US

V. Phone/Fax

Practice location:
  • Phone: 330-798-0491
  • Fax: 330-303-4948
Mailing address:
  • Phone: 330-798-0491
  • Fax: 330-303-4948

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN.CNP.15708
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: