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General NPI Number Information
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NPI Number | 1255895090
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Entity Type | Individual
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Provider Name | AUDREY LUJAN
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Gender | Female
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Dates
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Enumeration Date | 01/25/2019
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Last Update Date | 01/25/2019
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Provider Practice Location Address
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Address Line | 1090 GOAT SPRINGS ROAD
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City | TAOS
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State | NM
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Zip | 87571
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Country | US
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Telephone | 575-758-6966
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Fax | 575-751-5210
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Provider Business Mailing Address
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Address Line | P O BOX 310001-0670
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City | PASADENA
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State | CA
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Zip | 91110-0670
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Country | US
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Telephone | 575-758-6966
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Fax | 575-751-5210
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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 | 163WG0000X
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Taxonomy Name | General Practice Registered Nurse
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License Number | R61659
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License Number State | NM
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