1063091171 NPI number — CYNTHIA ANN LALUZERNE APNP

Table of content: CYNTHIA ANN LALUZERNE APNP (NPI 1063091171)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063091171 NPI number — CYNTHIA ANN LALUZERNE APNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LALUZERNE
Provider First Name:
CYNTHIA
Provider Middle Name:
ANN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
APNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
FARRELL
Provider Other First Name:
CYNTHIA
Provider Other Middle Name:
ANN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
APNP
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1063091171
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/10/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
323 S 18TH AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
STURGEON BAY
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
54235-1401
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
920-743-5566
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
815 JEFFERSON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALGOMA
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
54201-1733
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
920-487-3496
Provider Business Practice Location Address Fax Number:
920-487-0275
Provider Enumeration Date:
04/06/2021

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  10522 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: F06202416 . This is a "AMERICAN ACADEMY OF NURSE PRACTITIONERS" identifier . This identifiers is of the category "OTHER".




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