Healthcare Provider Details

I. General information

NPI: 1255220224
Provider Name (Legal Business Name): LUNARIS HEALTH PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2025
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17212 N SCOTTSDALE RD
SCOTTSDALE AZ
85255-9615
US

IV. Provider business mailing address

830 CARPENTER AVE
OAK PARK IL
60304-1109
US

V. Phone/Fax

Practice location:
  • Phone: 708-427-8700
  • Fax:
Mailing address:
  • Phone: 708-427-8700
  • Fax: 385-900-1662

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MELTEM RANDLE
Title or Position: OWNER / NURSE PRACTITIONER
Credential: AGACNP-BC
Phone: 708-427-8700