Healthcare Provider Details

I. General information

NPI: 1356985428
Provider Name (Legal Business Name): JAMIE RENNE LUJAN DNP, CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2019
Last Update Date: 11/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3865 E LOHMAN AVE STE 4
LAS CRUCES NM
88011-8292
US

IV. Provider business mailing address

3865 E LOHMAN AVE STE 4
LAS CRUCES NM
88011-8292
US

V. Phone/Fax

Practice location:
  • Phone: 575-491-5085
  • Fax: 575-532-1778
Mailing address:
  • Phone: 575-491-5085
  • Fax: 575-532-1778

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number58255
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: