Provider Demographics
NPI:1487619243
Name:LUNA, LIANNE R (NURSE PRACTITIONER)
Entity type:Individual
Prefix:
First Name:LIANNE
Middle Name:R
Last Name:LUNA
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6204 W LARKSPUR DR
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85304-1707
Mailing Address - Country:US
Mailing Address - Phone:623-486-4743
Mailing Address - Fax:602-239-5295
Practice Address - Street 1:901 E WILLETTA ST
Practice Address - Street 2:SUITE #3503
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85006-2727
Practice Address - Country:US
Practice Address - Phone:602-239-5166
Practice Address - Fax:602-239-5295
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN042263363LN0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal