Provider Demographics
NPI:1639243066
Name:LUKSAN, MESHA L (APRN)
Entity Type:Individual
Prefix:MS
First Name:MESHA
Middle Name:L
Last Name:LUKSAN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:MESHA
Other - Middle Name:L
Other - Last Name:BUMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:TWO WEST 42ND STREET L SUITE 1200
Mailing Address - Street 2:REGIONAL WEST MEDICAL PLAZA NORTH
Mailing Address - City:SCOTTSBLUFF
Mailing Address - State:NE
Mailing Address - Zip Code:69361
Mailing Address - Country:US
Mailing Address - Phone:308-630-1478
Mailing Address - Fax:
Practice Address - Street 1:TWO WEST 42ND STREET L SUITE 1200
Practice Address - Street 2:REGIONAL WEST MEDICAL PLAZA NORTH
Practice Address - City:SCOTTSBLUFF
Practice Address - State:NE
Practice Address - Zip Code:69361
Practice Address - Country:US
Practice Address - Phone:308-630-1478
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-18
Last Update Date:2013-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE54938363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE38742OtherBCBS