MEDICARE: LISA JO LOFTIS RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WX0200X	Oncology Registered Nurse	54451	NM

General Provider Information

NPI Number	:	1174479364
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA JO LOFTIS RN

Provider Business Mailing Address
First Line	:	3816 ALTEZ ST NE
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87111-3305
Country	:	US
Telephone Number	:	505-712-0188
Fax Number	:

Provider Business Practice Location Address
First Line	:	3816 ALTEZ ST NE
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87111-3305
Country	:	US
Telephone Number	:	505-712-0188
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/09/2026
Last Update Date	:	03/09/2026

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