Provider Demographics
NPI:1659544419
Name:LOUGH, JOANNE (RN)
Entity Type:Individual
Prefix:
First Name:JOANNE
Middle Name:
Last Name:LOUGH
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:JOANNE
Other - Middle Name:
Other - Last Name:GOSTISCHA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:107 AVENUE N
Mailing Address - Street 2:
Mailing Address - City:MATAMORAS
Mailing Address - State:PA
Mailing Address - Zip Code:18336-1417
Mailing Address - Country:US
Mailing Address - Phone:570-491-4612
Mailing Address - Fax:570-491-4001
Practice Address - Street 1:107 AVENUE N
Practice Address - Street 2:
Practice Address - City:MATAMORAS
Practice Address - State:PA
Practice Address - Zip Code:18336-1417
Practice Address - Country:US
Practice Address - Phone:570-491-4612
Practice Address - Fax:570-491-4001
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-11
Last Update Date:2008-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY454683163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02228302Medicaid