Provider Demographics
NPI:1366249823
Name:LOOMIS, CASEY NICOLE
Entity type:Individual
Prefix:
First Name:CASEY
Middle Name:NICOLE
Last Name:LOOMIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CASEY
Other - Middle Name:NICOLE
Other - Last Name:REDDICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:535 TIOGA TRL
Mailing Address - Street 2:
Mailing Address - City:WILLOUGHBY
Mailing Address - State:OH
Mailing Address - Zip Code:44094-7264
Mailing Address - Country:US
Mailing Address - Phone:216-970-7099
Mailing Address - Fax:
Practice Address - Street 1:535 TIOGA TRL
Practice Address - Street 2:
Practice Address - City:WILLOUGHBY
Practice Address - State:OH
Practice Address - Zip Code:44094-7264
Practice Address - Country:US
Practice Address - Phone:216-970-7099
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-03
Last Update Date:2025-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372500000XNursing Service Related ProvidersChore Provider