Provider Demographics
NPI:1407969744
Name:WOSICK, LUANN MARY (CFNP)
Entity Type:Individual
Prefix:MS
First Name:LUANN
Middle Name:MARY
Last Name:WOSICK
Suffix:
Gender:F
Credentials:CFNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 148
Mailing Address - Street 2:ORTIZ MOUNTAIN HEALTH CENTER
Mailing Address - City:CERRILLOS
Mailing Address - State:NM
Mailing Address - Zip Code:87010
Mailing Address - Country:US
Mailing Address - Phone:505-471-6266
Mailing Address - Fax:505-471-5861
Practice Address - Street 1:06B MAIN STREET
Practice Address - Street 2:ORTIZ MOUNTAIN HEALTH CENTER
Practice Address - City:CERRILLOS
Practice Address - State:NM
Practice Address - Zip Code:87010
Practice Address - Country:US
Practice Address - Phone:505-471-6266
Practice Address - Fax:505-471-5861
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMR20436363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMR20436OtherPROVIDER NO BD OF NURSING
NMR20436OtherPROVIDER NO BD OF NURSING
S91785Medicare ID - Type Unspecified