Provider Demographics
NPI:1427663798
Name:LOEB, MARYJANE
Entity type:Individual
Prefix:
First Name:MARYJANE
Middle Name:
Last Name:LOEB
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:707 OBERLIN PL
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44515-4211
Mailing Address - Country:US
Mailing Address - Phone:330-398-4065
Mailing Address - Fax:
Practice Address - Street 1:707 OBERLIN PL
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44515-4211
Practice Address - Country:US
Practice Address - Phone:330-398-4065
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-13
Last Update Date:2020-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH26213723747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant