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NPI Code Detail

MEDICARE: JANINE CLOUGHERTY RN

MEDICARE:   JANINE  CLOUGHERTY  RN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1163W00000XRegistered Nurse505064NY

General Provider Information

NPI Number : 1255621611
Entity Type Code : Individual
Provider Name (Legal Business Name) : JANINE CLOUGHERTY RN
Provider Business Mailing Address
First Line : 492 18TH ST
Second Line :
City : WEST BABYLON
State : NY
Zip : 11704-2207
Country : US
Telephone Number : 631-374-8660
Fax Number :
Provider Business Practice Location Address
First Line : 492 18TH ST
Second Line :
City : WEST BABYLON
State : NY
Zip : 11704-2207
Country : US
Telephone Number : 631-374-8660
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/19/2011
Last Update Date : 04/19/2011

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