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General NPI Number Information
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NPI Number | 1316942899
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Entity Type | Individual
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Provider Name | LISA CLAIRE LOUGHERY CRNA
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Gender | Female
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Dates
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Enumeration Date | 06/20/2005
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Last Update Date | 05/12/2010
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Provider Practice Location Address
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Address Line | 1140 ROUTE 72 W
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City | MANAHAWKIN
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State | NJ
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Zip | 08050-2412
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Country | US
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Telephone | 609-597-6011
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 34672
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City | NEWARK
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State | NJ
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Zip | 07189-0001
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Country | US
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Telephone | 201-804-2800
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 26NR10190000
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | RN227018L
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License Number State | PA
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