Provider Demographics
NPI:1689780355
Name:PURVIS, LOIS MARY (PA LMT)
Entity Type:Individual
Prefix:
First Name:LOIS
Middle Name:MARY
Last Name:PURVIS
Suffix:
Gender:F
Credentials:PA LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 CEDAR ST
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87501-1638
Mailing Address - Country:US
Mailing Address - Phone:505-501-4192
Mailing Address - Fax:
Practice Address - Street 1:1421 LUISA ST
Practice Address - Street 2:SUITE D
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-4073
Practice Address - Country:US
Practice Address - Phone:505-820-1482
Practice Address - Fax:505-982-0696
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMPA2005-0046363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant