Healthcare Provider Details

I. General information

NPI: 1295135341
Provider Name (Legal Business Name): MATTHEW K LOEBER APRN-CNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2014
Last Update Date: 01/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

308 N W 153RD STREET
EDMOND OK
73013
US

IV. Provider business mailing address

308 N W 153RD STREET
EDMOND OK
73013
US

V. Phone/Fax

Practice location:
  • Phone: 405-888-9949
  • Fax: 405-272-7455
Mailing address:
  • Phone: 405-888-9949
  • Fax: 405-272-7455

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR98967
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: