Provider Demographics
NPI:1912023177
Name:LOUGHRAN, COLLEEN (NP)
Entity type:Individual
Prefix:
First Name:COLLEEN
Middle Name:
Last Name:LOUGHRAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10435 W SHADYBROOK DR
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83704-3945
Mailing Address - Country:US
Mailing Address - Phone:208-991-1636
Mailing Address - Fax:208-991-1985
Practice Address - Street 1:3308 N MILWAUKEE ST STE 120
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-1007
Practice Address - Country:US
Practice Address - Phone:208-991-1636
Practice Address - Fax:208-991-1985
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2025-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209029135363L00000X
CA12463363LF0000X
ID74406363L00000X
PATP004694B363L00000X
CANP12463363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1912023177OtherNPI
CABJ105ZMedicare PIN
S95253Medicare UPIN
CABJ067ZMedicare PIN
CABJ105YMedicare PIN