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General NPI Number Information
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NPI Number | 1467984799
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Entity Type | Individual
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Provider Name | LOREN DEPUTY
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Gender | Female
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Dates
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Enumeration Date | 03/27/2017
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Last Update Date | 10/14/2020
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Provider Practice Location Address
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Address Line | 408 N 1ST ST
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City | GLENWOOD
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State | AR
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Zip | 71943-9250
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Country | US
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Telephone | 870-356-1556
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Fax |
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Provider Business Mailing Address
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Address Line | 408 N 1ST ST STE C
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City | GLENWOOD
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State | AR
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Zip | 71943-9252
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Country | US
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Telephone | 870-356-1556
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | E13053
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License Number State | AR
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