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General NPI Number Information
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NPI Number | 1346906278
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Entity Type | Individual
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Provider Name | RICHARD PATRICK LOONAM JR. PMHNP
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Gender | Male
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Dates
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Enumeration Date | 11/15/2021
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Last Update Date | 09/10/2024
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Provider Practice Location Address
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Address Line | 5455 N UNION BLVD
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City | COLORADO SPRINGS
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State | CO
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Zip | 80918
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Country | US
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Telephone | 719-308-5450
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Fax |
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Provider Business Mailing Address
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Address Line | 5455 N UNION BLVD
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City | COLORADO SPRINGS
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State | CO
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Zip | 80918-2077
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Country | US
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Telephone |
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | APN.0998724-NP
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License Number State | CO
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