Provider Demographics
NPI:1285924134
Name:LOOS, KIM JOYCE (LPN)
Entity type:Individual
Prefix:MRS
First Name:KIM
Middle Name:JOYCE
Last Name:LOOS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:W3489 153 RD
Mailing Address - Street 2:
Mailing Address - City:LOYAL
Mailing Address - State:WI
Mailing Address - Zip Code:54446-8949
Mailing Address - Country:US
Mailing Address - Phone:715-937-3127
Mailing Address - Fax:
Practice Address - Street 1:W3489 153 RD
Practice Address - Street 2:
Practice Address - City:LOYAL
Practice Address - State:WI
Practice Address - Zip Code:54446-8949
Practice Address - Country:US
Practice Address - Phone:715-937-3127
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-12
Last Update Date:2011-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI312567-31164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse