Provider Demographics
NPI:1164745584
Name:LOUGHREY, BETTIE (NP)
Entity Type:Individual
Prefix:
First Name:BETTIE
Middle Name:
Last Name:LOUGHREY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:750 EAST ADAMS ST.
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13210-2375
Mailing Address - Country:US
Mailing Address - Phone:315-464-3265
Mailing Address - Fax:315-424-3745
Practice Address - Street 1:750 EAST ADAMS ST.
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13210
Practice Address - Country:US
Practice Address - Phone:315-464-3265
Practice Address - Fax:315-424-3745
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-12
Last Update Date:2018-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY402390363LP0808X
NY22-605331163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse