Provider Demographics
NPI:1427286756
Name:AGIS, LORETTA MARIE (RN, APNC)
Entity type:Individual
Prefix:MS
First Name:LORETTA
Middle Name:MARIE
Last Name:AGIS
Suffix:
Gender:F
Credentials:RN, APNC
Other - Prefix:MS
Other - First Name:LORI
Other - Middle Name:MARIE
Other - Last Name:AGIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:303 FRANKLIN AVE
Mailing Address - Street 2:
Mailing Address - City:WYCKOFF
Mailing Address - State:NJ
Mailing Address - Zip Code:07481-2095
Mailing Address - Country:US
Mailing Address - Phone:201-891-6660
Mailing Address - Fax:
Practice Address - Street 1:303 FRANKLIN AVE
Practice Address - Street 2:
Practice Address - City:WYCKOFF
Practice Address - State:NJ
Practice Address - Zip Code:07481-2095
Practice Address - Country:US
Practice Address - Phone:201-891-6660
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-25
Last Update Date:2019-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00201300363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily