Provider Demographics
NPI:1245212372
Name:LOUGHREY, DIANE S (FNP-C)
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:S
Last Name:LOUGHREY
Suffix:
Gender:F
Credentials:FNP-C
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 8519
Mailing Address - Street 2:
Mailing Address - City:RED BANK
Mailing Address - State:NJ
Mailing Address - Zip Code:07701-8519
Mailing Address - Country:US
Mailing Address - Phone:732-460-9840
Mailing Address - Fax:732-460-9848
Practice Address - Street 1:231 MAPLE AVE
Practice Address - Street 2:
Practice Address - City:RED BANK
Practice Address - State:NJ
Practice Address - Zip Code:07701-1727
Practice Address - Country:US
Practice Address - Phone:732-842-3050
Practice Address - Fax:732-530-0730
Is Sole Proprietor?:No
Enumeration Date:2005-11-15
Last Update Date:2011-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NN05052100363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0102288Medicaid
P00207997OtherMEDICARE RAILROAD
NJ0102288Medicaid
P00207997OtherMEDICARE RAILROAD