Healthcare Provider Details

I. General information

NPI: 1356703979
Provider Name (Legal Business Name): KRISLIN LOUKO NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/23/2016
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3350 ROUTE 138 BUILDING 2 SUITE 126
WALL NJ
07719
US

IV. Provider business mailing address

3350 ROUTE 138 BUILDING 2 SUITE 126
WALL NJ
07719
US

V. Phone/Fax

Practice location:
  • Phone: 732-280-6455
  • Fax: 732-280-6456
Mailing address:
  • Phone: 732-280-6455
  • Fax: 732-280-6456

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number26NJ00626600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: