Provider Demographics
NPI:1558942383
Name:LURTSEMA, NICA ELENA (MD)
Entity Type:Individual
Prefix:
First Name:NICA
Middle Name:ELENA
Last Name:LURTSEMA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:NICA
Other - Middle Name:ELENA
Other - Last Name:TAYLOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3601 4TH STREET
Mailing Address - Street 2:MAIL STOP 9901
Mailing Address - City:LUBBOCK,
Mailing Address - State:TX
Mailing Address - Zip Code:79430
Mailing Address - Country:US
Mailing Address - Phone:806-743-2752
Mailing Address - Fax:806-743-1180
Practice Address - Street 1:3601 4TH STREET
Practice Address - Street 2:MAIL STOP 9901
Practice Address - City:LUBBOCK,
Practice Address - State:TX
Practice Address - Zip Code:79430
Practice Address - Country:US
Practice Address - Phone:806-743-2752
Practice Address - Fax:806-743-1180
Is Sole Proprietor?:No
Enumeration Date:2021-04-14
Last Update Date:2021-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program