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General NPI Number Information
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NPI Number | 1053384495
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Entity Type | Individual
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Provider Name | DAVID MICHAEL LOFSTROM A.P.R.N.
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Gender | Male
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Dates
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Enumeration Date | 02/08/2006
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Last Update Date | 08/08/2012
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Provider Practice Location Address
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Address Line | 707 SOUTH VIENNA
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City | RUSTON
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State | LA
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Zip | 71270-5845
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Country | US
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Telephone | 318-251-8001
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Fax | 318-699-8845
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Provider Business Mailing Address
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Address Line | 1809 NORTHPOINTE LANE SUITE 203
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City | RUSTON
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State | LA
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Zip | 71270-3852
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Country | US
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Telephone | 318-251-8001
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Fax | 318-699-8843
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | RN073531
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License Number State | LA
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Taxonomy #2
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | RN073531
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License Number State | LA
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Taxonomy #3
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | RN073531-AP03121
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License Number State | LA
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