Provider Demographics
NPI:1154523546
Name:LOYALL, MARY ELLEN (CRNA)
Entity type:Individual
Prefix:MISS
First Name:MARY
Middle Name:ELLEN
Last Name:LOYALL
Suffix:
Gender:F
Credentials:CRNA
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Mailing Address - Street 1:50 SCHENCK PKWY
Mailing Address - Street 2:SUITE 300
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28803-3499
Mailing Address - Country:US
Mailing Address - Phone:828-681-1527
Mailing Address - Fax:828-681-1575
Practice Address - Street 1:76 PEACHTREE RD
Practice Address - Street 2:SUITE 300
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28803-3395
Practice Address - Country:US
Practice Address - Phone:828-274-3477
Practice Address - Fax:828-274-7407
Is Sole Proprietor?:No
Enumeration Date:2007-06-05
Last Update Date:2017-01-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SC3207367500000X
KY30005656APRN367500000X
NC282727367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000709989OtherBCBS
KY7100060170Medicaid
KY7100060170Medicaid