Provider Demographics
NPI:1285339945
Name:PRESUEL, LOUIEDETTE PAIGE
Entity type:Individual
Prefix:
First Name:LOUIEDETTE
Middle Name:PAIGE
Last Name:PRESUEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LOUIEDETTE
Other - Middle Name:PAIGE
Other - Last Name:MALING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1001 YUZU WAY
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92374-2261
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11306 MOUNTAIN VIEW AVE STE B
Practice Address - Street 2:
Practice Address - City:LOMA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92354-3832
Practice Address - Country:US
Practice Address - Phone:909-361-6987
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-03
Last Update Date:2024-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95032245363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily