Provider Demographics
NPI:1275534083
Name:LOONEY, PATSY (FNP)
Entity Type:Individual
Prefix:
First Name:PATSY
Middle Name:
Last Name:LOONEY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 SW 3RD ST
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:OR
Mailing Address - Zip Code:97914-2742
Mailing Address - Country:US
Mailing Address - Phone:541-889-2340
Mailing Address - Fax:541-889-2593
Practice Address - Street 1:7 SW 3RD ST
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:OR
Practice Address - Zip Code:97914-2742
Practice Address - Country:US
Practice Address - Phone:541-889-2340
Practice Address - Fax:541-889-2593
Is Sole Proprietor?:No
Enumeration Date:2005-08-02
Last Update Date:2007-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR00022623363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORP23865Medicare UPIN