Healthcare Provider Details

I. General information

NPI: 1841625852
Provider Name (Legal Business Name): ALEXA S LUJAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2013
Last Update Date: 01/04/2024
Certification Date: 01/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 CENTRAL AVE SE
ALBUQUERQUE NM
87106-4930
US

IV. Provider business mailing address

7305 PEBBLE STONE PL NE
ALBUQUERQUE NM
87113-2118
US

V. Phone/Fax

Practice location:
  • Phone: 505-841-1090
  • Fax:
Mailing address:
  • Phone: 505-250-9936
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License NumberR44106
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License NumberCNP-02259
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: