Provider Demographics
NPI:1124120688
Name:LOUGHRY, BRETA CLAIRE (CNP)
Entity type:Individual
Prefix:
First Name:BRETA
Middle Name:CLAIRE
Last Name:LOUGHRY
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:BRETA
Other - Middle Name:CLAIRE
Other - Last Name:LOUGHRY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:FNP-C
Mailing Address - Street 1:640 HIGH ST UNIT 1
Mailing Address - Street 2:
Mailing Address - City:ESTES PARK
Mailing Address - State:CO
Mailing Address - Zip Code:80517-7665
Mailing Address - Country:US
Mailing Address - Phone:303-618-1787
Mailing Address - Fax:970-577-4363
Practice Address - Street 1:640 HIGH ST UNIT 1
Practice Address - Street 2:
Practice Address - City:ESTES PARK
Practice Address - State:CO
Practice Address - Zip Code:80517
Practice Address - Country:US
Practice Address - Phone:303-618-1787
Practice Address - Fax:970-577-4363
Is Sole Proprietor?:No
Enumeration Date:2006-09-03
Last Update Date:2019-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0003130363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
COF0800341OtherAANPCP
CO0001436OtherAANPCP
CO58195OtherLICENSE