Provider Demographics
NPI:1356985428
Name:LUJAN, JAMIE RENNE (DNP, CNP)
Entity type:Individual
Prefix:DR
First Name:JAMIE
Middle Name:RENNE
Last Name:LUJAN
Suffix:
Gender:F
Credentials:DNP, CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3865 E LOHMAN AVE STE 4
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88011-8292
Mailing Address - Country:US
Mailing Address - Phone:575-491-5085
Mailing Address - Fax:575-532-1778
Practice Address - Street 1:3865 E LOHMAN AVE STE 4
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011-8292
Practice Address - Country:US
Practice Address - Phone:575-491-5085
Practice Address - Fax:575-532-1778
Is Sole Proprietor?:No
Enumeration Date:2019-11-01
Last Update Date:2019-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM58255363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily