1750559571 NPI number — EVERETT CLIFTON LOFTON BSN,RN,CRNI

Table of content: EVERETT CLIFTON LOFTON BSN,RN,CRNI (NPI 1750559571)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750559571 NPI number — EVERETT CLIFTON LOFTON BSN,RN,CRNI

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LOFTON
Provider First Name:
EVERETT
Provider Middle Name:
CLIFTON
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
BSN,RN,CRNI
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1750559571
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/14/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7159 HICKORY GROVE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DEVILLE
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
71328-8501
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
318-466-5366
Provider Business Mailing Address Fax Number:
318-466-5150

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7159 HICKORY GROVE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DEVILLE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
71328-8501
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
318-466-5366
Provider Business Practice Location Address Fax Number:
318-466-5150
Provider Enumeration Date:
02/14/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 163WI0500X , with the licence number:  RN042490 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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