MEDICARE: LUNAR PSYCHIATRY

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
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner

General Provider Information

NPI Number	:	1275316994
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LUNAR PSYCHIATRY

Provider Business Mailing Address
First Line	:	3409 SOUTH BLVD
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43204-1213
Country	:	US
Telephone Number	:	614-806-5157
Fax Number	:

Provider Business Practice Location Address
First Line	:	3409 SOUTH BLVD
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43204-1213
Country	:	US
Telephone Number	:	614-806-5157
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	SUBAN A WARSAME
Credential	:	CNP
Telephone Number	:	614-806-5157

Provider Enumeration Date	:	08/16/2023
Last Update Date	:	08/30/2024

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Directions to “LUNAR PSYCHIATRY ” Practice Location

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