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General NPI Number Information
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NPI Number | 1083147334
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Entity Type | Individual
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Provider Name | ELIZABETH APOLLO-LOOMIS APNP
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Gender | Female
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Dates
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Enumeration Date | 04/04/2017
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Last Update Date | 02/13/2023
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Provider Practice Location Address
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Address Line | 1401 N 10TH AVE
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City | STAYTON
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State | OR
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Zip | 97383-1311
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Country | US
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Telephone | 503-769-9307
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Fax |
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Provider Business Mailing Address
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Address Line | 28975 SW ORLEANS AVE APT 307
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City | WILSONVILLE
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State | OR
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Zip | 97070-7357
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | 7618-33
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | 201709153NP-PP
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License Number State | OR
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