Basic Information
| Provider Information | |||||||||
| NPI: | 1114224854 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BASS | ||||||||
| FirstName: | LOREN | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | CRNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 395 NORTHWOOD DR | ||||||||
| Address2: | |||||||||
| City: | CENTRE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 359601045 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2569274900 | ||||||||
| FaxNumber: | 2569279151 | ||||||||
| Practice Location | |||||||||
| Address1: | 395 NORTHWOOD DR | ||||||||
| Address2: | |||||||||
| City: | CENTRE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 359601045 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2569274900 | ||||||||
| FaxNumber: | 2569279151 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/15/2011 | ||||||||
| LastUpdateDate: | 06/04/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | 06/04/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 1-107686 | AL | N | Nursing Service Providers | Registered Nurse | 363LF0000X | F0211066 | AL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.