Provider Demographics
NPI: | 1851728745 |
---|---|
Name: | LULU SERVICES PLLC |
Entity Type: | Organization |
Organization Name: | LULU SERVICES PLLC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | AUTHORIZED OFFICIAL |
Authorized Official - Prefix: | MS |
Authorized Official - First Name: | RENATA |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | PEYREAU |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 281-463-6309 |
Mailing Address - Street 1: | 7 BRANDENBERRY CT |
Mailing Address - Street 2: | |
Mailing Address - City: | THE WOODLANDS |
Mailing Address - State: | TX |
Mailing Address - Zip Code: | 77381-5110 |
Mailing Address - Country: | US |
Mailing Address - Phone: | |
Mailing Address - Fax: | |
Practice Address - Street 1: | 7 BRANDENBERRY CT |
Practice Address - Street 2: | |
Practice Address - City: | THE WOODLANDS |
Practice Address - State: | TX |
Practice Address - Zip Code: | 77381-5110 |
Practice Address - Country: | US |
Practice Address - Phone: | 821-463-6309 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2013-10-09 |
Last Update Date: | 2014-08-15 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
TX | 727437 | 363L00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 363L00000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Group - Multi-Specialty |