Healthcare Provider Details

I. General information

NPI: 1174152656
Provider Name (Legal Business Name): LUNA KAHSAY RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/06/2020
Last Update Date: 04/06/2020
Certification Date: 04/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1802 6TH AVE S
BIRMINGHAM AL
35233-1932
US

IV. Provider business mailing address

3545 GRANDVIEW PKWY APT 303
BIRMINGHAM AL
35243-2073
US

V. Phone/Fax

Practice location:
  • Phone: 678-787-7811
  • Fax:
Mailing address:
  • Phone: 678-787-7811
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number1-174114
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: