Healthcare Provider Details

I. General information

NPI: 1174479364
Provider Name (Legal Business Name): LISA JO LOFTIS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/09/2026
Last Update Date: 03/09/2026
Certification Date: 03/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3816 ALTEZ ST NE
ALBUQUERQUE NM
87111-3305
US

IV. Provider business mailing address

3816 ALTEZ ST NE
ALBUQUERQUE NM
87111-3305
US

V. Phone/Fax

Practice location:
  • Phone: 505-712-0188
  • Fax:
Mailing address:
  • Phone: 505-712-0188
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WX0200X
TaxonomyOncology Registered Nurse
License Number54451
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: