Provider Demographics
NPI:1417396607
Name:LU, NA (LVN)
Entity Type:Individual
Prefix:
First Name:NA
Middle Name:
Last Name:LU
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5815 THIRD STREET
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94404
Mailing Address - Country:US
Mailing Address - Phone:415-822-7500
Mailing Address - Fax:415-822-9767
Practice Address - Street 1:5815 THIRD STREET
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94404
Practice Address - Country:US
Practice Address - Phone:415-822-7500
Practice Address - Fax:415-822-9767
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-20
Last Update Date:2013-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN265461164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse