MEDICARE: MR. EDWARD RAY LOBAUGH CNP, CNS, APRN BC

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	R45675	NM

General Provider Information

NPI Number	:	1588686158
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. EDWARD RAY LOBAUGH CNP, CNS, APRN BC

Provider Business Mailing Address
First Line	:	7 CALIENTE RD UNIT B1
Second Line	:
City	:	SANTA FE
State	:	NM
Zip	:	87508-3104
Country	:	US
Telephone Number	:	505-216-7772
Fax Number	:	505-557-6699

Provider Business Practice Location Address
First Line	:	7 CALIENTE RD UNIT B1
Second Line	:
City	:	SANTA FE
State	:	NM
Zip	:	87508-3104
Country	:	US
Telephone Number	:	505-216-7772
Fax Number	:	505-557-6699

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

Provider Enumeration Date	:	07/24/2006
Last Update Date	:	10/16/2018

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