MEDICARE: JOEL LUNA CERALDE FNP-C

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	363LF0000X	Family Nurse Practitioner	209.017683	IL

General Provider Information

NPI Number	:	1770074486
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOEL LUNA CERALDE FNP-C

Provider Business Mailing Address
First Line	:	3663 SONOMA CIR
Second Line	:
City	:	LAKE IN THE HILLS
State	:	IL
Zip	:	60156-6729
Country	:	US
Telephone Number	:	224-569-6490
Fax Number	:

Provider Business Practice Location Address
First Line	:	3663 SONOMA CIR
Second Line	:
City	:	LAKE IN THE HILLS
State	:	IL
Zip	:	60156-6729
Country	:	US
Telephone Number	:	224-569-6490
Fax Number	:

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

Provider Enumeration Date	:	05/29/2018
Last Update Date	:	05/29/2018

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