Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | AP07096 | LA |
NPI | 1003168071 |
---|---|
Provider Name | Ms. Jaime Rebecca Loebner |
First Address | Mandeville, LA 70448-5520 |
Second Address | Slidell, LA 70458-1350 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/10/2012 |
Last Update Date | 15/10/2012 |