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NPI Code Detail

MEDICARE: JOSEPH PETER LULICH FNP-C

MEDICARE: JOSEPH PETER LULICH 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
1363LF0000XFamily Nurse Practitioner201150029OR

General Provider Information

NPI Number : 1134451784
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOSEPH PETER LULICH FNP-C
Provider Business Mailing Address
First Line : PO BOX 47
Second Line :
City : MILL CITY
State : OR
Zip : 97360-0047
Country : US
Telephone Number : 503-897-4100
Fax Number : 503-897-2673
Provider Business Practice Location Address
First Line : 280 S 1ST AVE
Second Line :
City : MILL CITY
State : OR
Zip : 97360-2324
Country : US
Telephone Number : 503-897-4100
Fax Number : 503-897-2673
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/08/2010
Last Update Date : 09/30/2020

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