Healthcare Provider Details

I. General information

NPI: 1730968587
Provider Name (Legal Business Name): MARY LOEHR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SKIP LOEHR

II. Dates (important events)

Enumeration Date: 09/21/2023
Last Update Date: 09/12/2025
Certification Date: 09/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4253 MONTGOMERY BLVD NE STE G130
ALBUQUERQUE NM
87109-1106
US

IV. Provider business mailing address

334 W ZIA RD
SANTA FE NM
87505-5723
US

V. Phone/Fax

Practice location:
  • Phone: 505-554-1283
  • Fax: 505-207-6167
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: