Provider Demographics
NPI:1629546767
Name:LUNA, LACI LEANNE (LVN)
Entity Type:Individual
Prefix:
First Name:LACI
Middle Name:LEANNE
Last Name:LUNA
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 1:203 MEMORY LN APT B
Mailing Address - Street 2:
Mailing Address - City:WHITEHOUSE
Mailing Address - State:TX
Mailing Address - Zip Code:75791-3680
Mailing Address - Country:US
Mailing Address - Phone:903-426-8106
Mailing Address - Fax:
Practice Address - Street 1:203 MEMORY LN APT B
Practice Address - Street 2:
Practice Address - City:WHITEHOUSE
Practice Address - State:TX
Practice Address - Zip Code:75791-3680
Practice Address - Country:US
Practice Address - Phone:903-426-8106
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-07
Last Update Date:2018-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX321716164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse