Provider Demographics
NPI:1407007974
Name:LOFGREN-MCCARTHY, JUNE MARIE (RN, NP, PHN)
Entity Type:Individual
Prefix:
First Name:JUNE
Middle Name:MARIE
Last Name:LOFGREN-MCCARTHY
Suffix:
Gender:F
Credentials:RN, NP, PHN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1998 NICHOLAS CT
Mailing Address - Street 2:
Mailing Address - City:WHITE BEAR LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55110-4375
Mailing Address - Country:US
Mailing Address - Phone:651-653-7563
Mailing Address - Fax:651-653-7564
Practice Address - Street 1:555 CEDAR ST
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55101-2209
Practice Address - Country:US
Practice Address - Phone:651-266-1272
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-02
Last Update Date:2008-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR 074316-3363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health