Provider Demographics
NPI:1528676129
Name:LOOSE, EVELYN RENEE
Entity type:Individual
Prefix:
First Name:EVELYN
Middle Name:RENEE
Last Name:LOOSE
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 1:110 E BRENTWOOD ST
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75604-2001
Mailing Address - Country:US
Mailing Address - Phone:903-746-9771
Mailing Address - Fax:
Practice Address - Street 1:110 E BRENTWOOD ST
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75604-2001
Practice Address - Country:US
Practice Address - Phone:903-746-9771
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-20
Last Update Date:2020-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care