Provider Demographics
NPI:1790843548
Name:LOUGHRAN, MARCIA BRADY (FNP)
Entity Type:Individual
Prefix:MS
First Name:MARCIA
Middle Name:BRADY
Last Name:LOUGHRAN
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 1:2168 19TH ST
Mailing Address - Street 2:APT 1
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11105-3933
Mailing Address - Country:US
Mailing Address - Phone:718-267-7174
Mailing Address - Fax:
Practice Address - Street 1:31-51 STONEY ST.
Practice Address - Street 2:PHEONIX HOUSE
Practice Address - City:SHRUB OAK
Practice Address - State:NY
Practice Address - Zip Code:10058
Practice Address - Country:US
Practice Address - Phone:914-962-2491
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF332129-1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00371673Medicaid
NYF332129-1Medicare UPIN