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NPI Code Detail

MEDICARE: DIANE VIRGINIA LOOS CAMU FNP

MEDICARE:   DIANE VIRGINIA LOOS CAMU  FNP
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
1363LF0000XFamily Nurse Practitioner5015735NC

General Provider Information

NPI Number : 1568116887
Entity Type Code : Individual
Provider Name (Legal Business Name) : DIANE VIRGINIA LOOS CAMU FNP
Provider Business Mailing Address
First Line : 5924 N HILLS DR
Second Line :
City : RALEIGH
State : NC
Zip : 27609-4236
Country : US
Telephone Number : 540-420-8015
Fax Number :
Provider Business Practice Location Address
First Line : 4414 LAKE BOONE TRL STE 505
Second Line :
City : RALEIGH
State : NC
Zip : 27607-7521
Country : US
Telephone Number : 919-784-2300
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/06/2022
Last Update Date : 05/13/2022

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Directions to “ DIANE VIRGINIA LOOS CAMU FNP” Practice Location

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