Healthcare Provider Details

I. General information

NPI: 1053830372
Provider Name (Legal Business Name): JENNIFER MARIE LUJAN CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/18/2017
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4410 IRVING BLVD NW STE 200
ALBUQUERQUE NM
87114-5951
US

IV. Provider business mailing address

1378 CALLE LA BONA TIERRA
BERNALILLO NM
87004-9149
US

V. Phone/Fax

Practice location:
  • Phone: 505-418-8919
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCNP-03366
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: