Provider Demographics
NPI:1740096155
Name:LUJAN, SHONTELLE ANTOINETTE (LPN)
Entity type:Individual
Prefix:
First Name:SHONTELLE
Middle Name:ANTOINETTE
Last Name:LUJAN
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2525 TINGLEY DR SW APT 305
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87104-1655
Mailing Address - Country:US
Mailing Address - Phone:505-819-7439
Mailing Address - Fax:
Practice Address - Street 1:2720 BROADBENT PKWY NE STE A
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87107-1623
Practice Address - Country:US
Practice Address - Phone:800-237-6257
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-10
Last Update Date:2024-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM75475164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse