Provider Demographics
NPI:1407858616
Name:LOEWEN, ANALISA MIRANDA (NP)
Entity type:Individual
Prefix:
First Name:ANALISA
Middle Name:MIRANDA
Last Name:LOEWEN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:ANALISA
Other - Middle Name:M
Other - Last Name:THIEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:100 S BOYLAN AVE
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27603-1802
Mailing Address - Country:US
Mailing Address - Phone:919-833-7526
Mailing Address - Fax:
Practice Address - Street 1:100 S BOYLAN AVE
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27603-1802
Practice Address - Country:US
Practice Address - Phone:919-833-7526
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-01
Last Update Date:2024-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5013936363LF0000X
CA21486363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000485492OtherANTHEM PIN - MARY ST
IN000000485495OtherANTHEM PIN - GATEWAY BLVD
IN200489350Medicaid
IN000000343152OtherBCBS PIN
IN182780NMedicare ID - Type Unspecified
IN200489350Medicaid
IN534980KKKMedicare PIN
INP00205381Medicare PIN