Provider Demographics
NPI: | 1568874089 |
---|---|
Name: | LU, YAN (NP) |
Entity Type: | Individual |
Prefix: | |
First Name: | YAN |
Middle Name: | |
Last Name: | LU |
Suffix: | |
Gender: | F |
Credentials: | NP |
Other - Prefix: | |
Other - First Name: | |
Other - Middle Name: | |
Other - Last Name: | |
Other - Suffix: | |
Other - Last Name Type: | |
Other - Credentials: | |
Mailing Address - Street 1: | 4112 AMBROSIA LN |
Mailing Address - Street 2: | |
Mailing Address - City: | PLANO |
Mailing Address - State: | TX |
Mailing Address - Zip Code: | 75093-6021 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 626-818-7149 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 7000 N. MOPAC |
Practice Address - Street 2: | SUITE 420 |
Practice Address - City: | AUSTIN |
Practice Address - State: | TX |
Practice Address - Zip Code: | 78731 |
Practice Address - Country: | US |
Practice Address - Phone: | 512-482-0045 |
Practice Address - Fax: | 512-476-9892 |
Is Sole Proprietor?: | Yes |
Enumeration Date: | 2014-06-02 |
Last Update Date: | 2017-03-08 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
CA | 95000530 | 363L00000X |
TX | AP132258 | 363LA2100X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 363LA2100X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Acute Care |
No | 363L00000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
CA | 95000530 | Other | CALIFORNIA STATE BOARD OF NURSING |
TX | 538332YM8A | Medicare PIN |