MEDICARE: THERESA ANN LOE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	124Q00000X	Dental Hygienist	DH60494182	WA

General Provider Information

NPI Number	:	1497228449
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THERESA ANN LOE

Provider Business Mailing Address
First Line	:	2112 W RIVERSIDE AVE APT 3
Second Line	:
City	:	SPOKANE
State	:	WA
Zip	:	99201-1431
Country	:	US
Telephone Number	:	509-954-5809
Fax Number	:

Provider Business Practice Location Address
First Line	:	2112 W RIVERSIDE AVE APT 3
Second Line	:
City	:	SPOKANE
State	:	WA
Zip	:	99201-1431
Country	:	US
Telephone Number	:	509-954-5809
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/02/2019
Last Update Date	:	01/02/2019

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Directions to “ THERESA ANN LOE ” Practice Location

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