Provider Demographics
NPI:1366652893
Name:LOYD, GEORGE DOUGLAS (RN)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:DOUGLAS
Last Name:LOYD
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4200 HOLIDAY DR
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:NM
Mailing Address - Zip Code:87402-4638
Mailing Address - Country:US
Mailing Address - Phone:505-327-4215
Mailing Address - Fax:505-327-0159
Practice Address - Street 1:1750 E 30TH ST
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:NM
Practice Address - Zip Code:87401
Practice Address - Country:US
Practice Address - Phone:505-327-0333
Practice Address - Fax:505-327-0159
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMR29485163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMR29485OtherREGISTERED NURSE LICENSE