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General NPI Number Information
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NPI Number | 1770180564
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Entity Type | Organization
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Legal Business Name | LUMINOUS HEALTH AND WELLNESS LLC
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Dates
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Enumeration Date | 10/05/2020
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Last Update Date | 10/05/2020
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Provider Practice Location Address
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Address Line | 1717 S CORAL TER
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City | N LAUDERDALE
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State | FL
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Zip | 33068-4129
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Country | US
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Telephone | 754-281-8638
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Fax |
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Provider Business Mailing Address
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Address Line | 1717 S CORAL TER
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City | N LAUDERDALE
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State | FL
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Zip | 33068-4129
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO/ OWNER
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Name | MARCIA WALKER
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Credential | APRN, FNP-BC
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Telephone | 754-281-8638
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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