Basic Information
| Provider Information | |||||||||
| NPI: | 1629467279 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NEISWENDER | ||||||||
| FirstName: | LOREN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 652 WENG STAR ST | ||||||||
| Address2: | |||||||||
| City: | BEAUMONT | ||||||||
| State: | CA | ||||||||
| PostalCode: | 922236825 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9099133806 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3208 ROSEMEAD BLVD | ||||||||
| Address2: | 200 | ||||||||
| City: | EL MONTE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917312830 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6262277014 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/21/2015 | ||||||||
| LastUpdateDate: | 06/13/2016 | ||||||||
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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 | 363L00000X | 95003904 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.