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NPI Code Detail

MEDICARE: LILLIE ANN LOOSE

MEDICARE:   LILLIE ANN LOOSE
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
1390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1881525442
Entity Type Code : Individual
Provider Name (Legal Business Name) : LILLIE ANN LOOSE
Provider Business Mailing Address
First Line : 5323 HARRY HINES BLVD
Second Line :
City : DALLAS
State : TX
Zip : 75390-2168
Country : US
Telephone Number : 214-648-2168
Fax Number : 214-648-7517
Provider Business Practice Location Address
First Line : 5323 HARRY HINES BLVD
Second Line :
City : DALLAS
State : TX
Zip : 75390-9006
Country : US
Telephone Number : 214-648-2168
Fax Number : 214-648-7517
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/25/2026
Last Update Date : 05/25/2026

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Directions to “ LILLIE ANN LOOSE ” Practice Location

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