1861685448 NPI number — JULIE LEE LUKE RN, C-PNP

Table of content: JULIE LEE LUKE RN, C-PNP (NPI 1861685448)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861685448 NPI number — JULIE LEE LUKE RN, C-PNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LUKE
Provider First Name:
JULIE
Provider Middle Name:
LEE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
RN, C-PNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WERNETTE
Provider Other First Name:
JULIE
Provider Other Middle Name:
LEE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
RN
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1861685448
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/06/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4410 MEDICAL DR STE 550
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN ANTONIO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78229-3755
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
210-575-2222
Provider Business Mailing Address Fax Number:
210-575-6131

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4410 MEDICAL DR STE 550
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN ANTONIO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78229-3755
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-575-2222
Provider Business Practice Location Address Fax Number:
210-575-6131
Provider Enumeration Date:
08/27/2007

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: 163WP0218X , with the licence number:  256206 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LP0200X , with the licence number: 256206 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363L00000X , with the licence number: 256206 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 193386309 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8CC920 . This is a "BCBS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 193386307 . This is a "MEDICAID - CSHCN" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".