Provider Demographics
NPI:1255443834
Name:MCLAUGHLIN, JOANNE V (FNP-C)
Entity type:Individual
Prefix:
First Name:JOANNE
Middle Name:V
Last Name:MCLAUGHLIN
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 340
Mailing Address - Street 2:
Mailing Address - City:NEW HARTFORD
Mailing Address - State:NY
Mailing Address - Zip Code:13413-0340
Mailing Address - Country:US
Mailing Address - Phone:315-732-9368
Mailing Address - Fax:315-732-9403
Practice Address - Street 1:54178 STATE HIGHWAY 30
Practice Address - Street 2:
Practice Address - City:ROXBURY
Practice Address - State:NY
Practice Address - Zip Code:12474-1543
Practice Address - Country:US
Practice Address - Phone:607-326-7791
Practice Address - Fax:607-326-7794
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2008-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF332442-1363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02061287Medicaid
NY93N45EJ001Medicare PIN
NY02061287Medicaid