Healthcare Provider Details

I. General information

NPI: 1043213788
Provider Name (Legal Business Name): JOHN M. LUJANAC APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2005
Last Update Date: 02/09/2024
Certification Date: 02/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 CHURCH HILL RD
SANDY HOOK CT
06482-1194
US

IV. Provider business mailing address

68 WALNUT TREE HILL RD
SANDY HOOK CT
06482-1073
US

V. Phone/Fax

Practice location:
  • Phone: 203-257-3130
  • Fax: 877-529-2920
Mailing address:
  • Phone: 203-257-3130
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number2370
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number002370
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: