Healthcare Provider Details

I. General information

NPI: 1396081816
Provider Name (Legal Business Name): MARY M LOFTIS BSN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/03/2013
Last Update Date: 01/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

698 HOWARD ST
SPARTANBURG SC
29303-2964
US

IV. Provider business mailing address

PO BOX 970
SPARTANBURG SC
29304-0970
US

V. Phone/Fax

Practice location:
  • Phone: 864-594-4465
  • Fax: 864-594-4169
Mailing address:
  • Phone: 864-594-4465
  • Fax: 864-594-4169

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number27716
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: