Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LA2100X | Nurse Practitioner - Acute Care | SP017948 | PA |
Y | 363LA2200X | Nurse Practitioner - Adult Health | SP017948 | PA |
N | 363LG0600X | Nurse Practitioner - Gerontology | SP017948 | PA |
NPI | 1063977973 |
---|---|
Provider Name | Karen Loos |
First Address | Wallingford, PA 19086-6784 |
Second Address | Philadelphia, PA 19107-4316 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/02/2019 |
Last Update Date | 20/06/2019 |