Provider Demographics
NPI:1861685448
Name:LUKE, JULIE LEE (RN, C-PNP)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:LEE
Last Name:LUKE
Suffix:
Gender:F
Credentials:RN, C-PNP
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:LEE
Other - Last Name:WERNETTE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:4410 MEDICAL DR STE 550
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-3755
Mailing Address - Country:US
Mailing Address - Phone:210-575-2222
Mailing Address - Fax:210-575-6131
Practice Address - Street 1:4410 MEDICAL DR STE 550
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-3755
Practice Address - Country:US
Practice Address - Phone:210-575-2222
Practice Address - Fax:210-575-6131
Is Sole Proprietor?:No
Enumeration Date:2007-08-27
Last Update Date:2019-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX256206163WP0218X, 363LP0200X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163WP0218XNursing Service ProvidersRegistered NursePediatric Oncology
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX193386309Medicaid
TX8CC920OtherBCBS
TX193386307OtherMEDICAID - CSHCN
TX193386306Medicaid
TX193386306Medicaid