Provider Demographics
NPI:1538682026
Name:O'LOUGHLIN, CHRISTENE ANN (FNP)
Entity Type:Individual
Prefix:
First Name:CHRISTENE
Middle Name:ANN
Last Name:O'LOUGHLIN
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:PO BOX 1257
Mailing Address - Street 2:
Mailing Address - City:HANNIBAL
Mailing Address - State:MO
Mailing Address - Zip Code:63401-1257
Mailing Address - Country:US
Mailing Address - Phone:636-293-4303
Mailing Address - Fax:
Practice Address - Street 1:905 HIGHWAY 161
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:MO
Practice Address - Zip Code:63334-2431
Practice Address - Country:US
Practice Address - Phone:573-754-5555
Practice Address - Fax:573-754-5932
Is Sole Proprietor?:No
Enumeration Date:2017-07-17
Last Update Date:2018-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2007018062163W00000X
MO2017017849363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2017017849OtherSTATE NP LICENSE