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NPI Code Detail

MEDICARE: KELLY JO LUNA LPN

MEDICARE:   KELLY JO LUNA  LPN
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
1164W00000XLicensed Practical NurseLPN.148436.MEDS-IVOH

General Provider Information

NPI Number : 1710318431
Entity Type Code : Individual
Provider Name (Legal Business Name) : KELLY JO LUNA LPN
Provider Business Mailing Address
First Line : 4600 MONTGOMERY RD STE 400
Second Line :
City : CINCINNATI
State : OH
Zip : 45212-2600
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1505 N COLE ST
Second Line :
City : LIMA
State : OH
Zip : 45801-2432
Country : US
Telephone Number : 833-510-4357
Fax Number : 866-460-2997
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/05/2013
Last Update Date : 01/12/2024

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