Provider Demographics
NPI:1043213788
Name:LUJANAC, JOHN M (APRN)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:M
Last Name:LUJANAC
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:68 WALNUT TREE HILL RD
Mailing Address - Street 2:
Mailing Address - City:SANDY HOOK
Mailing Address - State:CT
Mailing Address - Zip Code:06482-1073
Mailing Address - Country:US
Mailing Address - Phone:203-257-3130
Mailing Address - Fax:
Practice Address - Street 1:107 CHURCH HILL RD
Practice Address - Street 2:
Practice Address - City:SANDY HOOK
Practice Address - State:CT
Practice Address - Zip Code:06482-1194
Practice Address - Country:US
Practice Address - Phone:203-257-3130
Practice Address - Fax:877-529-2920
Is Sole Proprietor?:No
Enumeration Date:2005-05-25
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT2370363LP0808X
CT002370363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004218766Medicaid
NYP04039Medicare UPIN
CT004218766Medicaid
CTP04039Medicare UPIN