Provider Demographics
NPI:1235619669
Name:LUJAN, EDWARD (RN)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:
Last Name:LUJAN
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:503A BEVERLY DR
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78045-2111
Mailing Address - Country:US
Mailing Address - Phone:956-401-0645
Mailing Address - Fax:
Practice Address - Street 1:503A BEVERLY DR
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78045-2111
Practice Address - Country:US
Practice Address - Phone:956-401-0645
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-15
Last Update Date:2018-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX786058163WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WP0200XNursing Service ProvidersRegistered NursePediatricsGroup - Single Specialty