Basic Information
| Provider Information | |||||||||
| NPI: | 1154523546 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LOYALL | ||||||||
| FirstName: | MARY | ||||||||
| MiddleName: | ELLEN | ||||||||
| NamePrefix: | MISS | ||||||||
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| Credential: | CRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 50 SCHENCK PKWY | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | ASHEVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 288033499 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8286811527 | ||||||||
| FaxNumber: | 8286811575 | ||||||||
| Practice Location | |||||||||
| Address1: | 76 PEACHTREE RD | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | ASHEVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 288033395 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8282743477 | ||||||||
| FaxNumber: | 8282747407 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/05/2007 | ||||||||
| LastUpdateDate: | 01/16/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | 3207 | SC | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered | 367500000X | 30005656APRN | KY | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered | 367500000X | 282727 | NC | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
ID Information
| ID | Type | State | Issuer | Description | 000000709989 | 01 | KY | BCBS | OTHER | 7100060170 | 05 | KY | MEDICAID |