Provider Demographics
NPI:1548940158
Name:LOUGLAS, STEPHANIE ANNE (AGNP-C)
Entity type:Individual
Prefix:MISS
First Name:STEPHANIE
Middle Name:ANNE
Last Name:LOUGLAS
Suffix:
Gender:F
Credentials:AGNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 ELM ST
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD CLIFFS
Mailing Address - State:NJ
Mailing Address - Zip Code:07632-1509
Mailing Address - Country:US
Mailing Address - Phone:201-575-2245
Mailing Address - Fax:
Practice Address - Street 1:5 SUMMIT AVE
Practice Address - Street 2:
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-8503
Practice Address - Country:US
Practice Address - Phone:551-996-2900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-19
Last Update Date:2023-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ14868000363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health