Provider Demographics
NPI:1053384495
Name:LOFSTROM, DAVID MICHAEL (APRN)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:MICHAEL
Last Name:LOFSTROM
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
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Mailing Address - Street 1:1809 NORTHPOINTE LANE
Mailing Address - Street 2:SUITE 203
Mailing Address - City:RUSTON
Mailing Address - State:LA
Mailing Address - Zip Code:71270-3852
Mailing Address - Country:US
Mailing Address - Phone:318-251-8001
Mailing Address - Fax:318-699-8843
Practice Address - Street 1:707 SOUTH VIENNA
Practice Address - Street 2:
Practice Address - City:RUSTON
Practice Address - State:LA
Practice Address - Zip Code:71270-5845
Practice Address - Country:US
Practice Address - Phone:318-251-8001
Practice Address - Fax:318-699-8845
Is Sole Proprietor?:No
Enumeration Date:2006-02-08
Last Update Date:2012-08-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LARN073531363AM0700X, 363AS0400X
LARN073531-AP03121363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1698318Medicaid
LA1698318Medicaid
S62026Medicare UPIN
5X590Medicare PIN