Provider Demographics
NPI:1578739421
Name:LUX, GAIL YEREMIAN (FNP)
Entity Type:Individual
Prefix:
First Name:GAIL
Middle Name:YEREMIAN
Last Name:LUX
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:GAIL
Other - Middle Name:YEREMIAN
Other - Last Name:LUX
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:FNP
Mailing Address - Street 1:1414 PHYSICIANS DR
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28401-7335
Mailing Address - Country:US
Mailing Address - Phone:910-796-7990
Mailing Address - Fax:910-796-7901
Practice Address - Street 1:1414 PHYSICIANS DR
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401-7335
Practice Address - Country:US
Practice Address - Phone:910-796-7900
Practice Address - Fax:910-796-7901
Is Sole Proprietor?:No
Enumeration Date:2008-05-01
Last Update Date:2009-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC28569019207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAS25124Medicare UPIN