Provider Demographics
NPI:1891455200
Name:CALILUNG, MIRACRIS PAGULAYAN (NP)
Entity Type:Individual
Prefix:
First Name:MIRACRIS
Middle Name:PAGULAYAN
Last Name:CALILUNG
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:MIRACRIS
Other - Middle Name:CALILUNG
Other - Last Name:ARNOLD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1079 EASTERN PKWY
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40217-1559
Mailing Address - Country:US
Mailing Address - Phone:502-810-7117
Mailing Address - Fax:
Practice Address - Street 1:1079 EASTERN PKWY
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40217-1559
Practice Address - Country:US
Practice Address - Phone:502-810-7117
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-27
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3017064363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily