Provider Demographics
NPI:1871342055
Name:LOE, THERESE BERENGUER (FNP-C)
Entity type:Individual
Prefix:
First Name:THERESE
Middle Name:BERENGUER
Last Name:LOE
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 MANHATTAN SQ STE A
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23666-6262
Mailing Address - Country:US
Mailing Address - Phone:757-838-6335
Mailing Address - Fax:757-838-0612
Practice Address - Street 1:9 MANHATTAN SQ STE A
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23666-6262
Practice Address - Country:US
Practice Address - Phone:757-838-6335
Practice Address - Fax:757-838-0612
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-18
Last Update Date:2024-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024190195363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty