Provider Demographics
NPI:1366910895
Name:MCLOUGHLIN, CHARLOTTE MARIE (RN BSN CDE)
Entity type:Individual
Prefix:
First Name:CHARLOTTE
Middle Name:MARIE
Last Name:MCLOUGHLIN
Suffix:
Gender:F
Credentials:RN BSN CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3531 168TH ST
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11358-1732
Mailing Address - Country:US
Mailing Address - Phone:347-989-7838
Mailing Address - Fax:
Practice Address - Street 1:3531 168TH ST
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11358-1732
Practice Address - Country:US
Practice Address - Phone:347-989-7838
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-02
Last Update Date:2018-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY498075163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY2092-0440OtherNATIONAL CERTIFICATION BOARD FOR DIABETES EDUCATORS
NY498075OtherREGISTERED PROFESSIONAL NURSE