=====================================================
General NPI Number Information
=====================================================
NPI Number | 1689011520
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ANDREA MARIE MCLOUGHLIN , M.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/02/2013
-----------------------------------------------------
Last Update Date | 08/13/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 215 13TH AVE SW
-----------------------------------------------------
City | CLARION
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 50525-2078
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 515-532-2836
-----------------------------------------------------
Fax | 515-532-2523
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1316 S MAIN ST
-----------------------------------------------------
City | CLARION
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 50525-2019
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 515-532-2811
-----------------------------------------------------
Fax | 515-532-9336
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | MD60623728
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 42287
-----------------------------------------------------
License Number State | IA
-----------------------------------------------------