MEDICARE: LIANNE R LUNA NURSE PRACTITIONER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LN0000X	Neonatal Nurse Practitioner	RN042263	AZ

General Provider Information

NPI Number	:	1487619243
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LIANNE R LUNA NURSE PRACTITIONER

Provider Business Mailing Address
First Line	:	6204 W LARKSPUR DR
Second Line	:
City	:	GLENDALE
State	:	AZ
Zip	:	85304-1707
Country	:	US
Telephone Number	:	623-486-4743
Fax Number	:	602-239-5295

Provider Business Practice Location Address
First Line	:	901 E WILLETTA ST
Second Line	:	SUITE #3503
City	:	PHOENIX
State	:	AZ
Zip	:	85006-2727
Country	:	US
Telephone Number	:	602-239-5166
Fax Number	:	602-239-5295

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/17/2006
Last Update Date	:	07/08/2007

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