Provider Demographics
NPI:1376356873
Name:LOFTIN, BAMBI
Entity type:Individual
Prefix:
First Name:BAMBI
Middle Name:
Last Name:LOFTIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14203 SW HOLIDAY RD
Mailing Address - Street 2:
Mailing Address - City:FAXON
Mailing Address - State:OK
Mailing Address - Zip Code:73540-4018
Mailing Address - Country:US
Mailing Address - Phone:580-591-0533
Mailing Address - Fax:580-558-2470
Practice Address - Street 1:4301 WILSON ST
Practice Address - Street 2:
Practice Address - City:FORT SILL
Practice Address - State:OK
Practice Address - Zip Code:73503-4472
Practice Address - Country:US
Practice Address - Phone:580-558-8315
Practice Address - Fax:580-558-2470
Is Sole Proprietor?:No
Enumeration Date:2025-01-29
Last Update Date:2025-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0085638163W00000X, 163WP2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP2201XNursing Service ProvidersRegistered NurseAmbulatory Care
No163W00000XNursing Service ProvidersRegistered Nurse