Provider Demographics
NPI:1891548566
Name:LUNA, JANNELLE MAY (NP)
Entity Type:Individual
Prefix:
First Name:JANNELLE
Middle Name:MAY
Last Name:LUNA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5242 S COLLEGE DR STE 206
Mailing Address - Street 2:
Mailing Address - City:MURRAY
Mailing Address - State:UT
Mailing Address - Zip Code:84123-5548
Mailing Address - Country:US
Mailing Address - Phone:385-465-6452
Mailing Address - Fax:
Practice Address - Street 1:5242 S COLLEGE DR STE 206
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84123-5548
Practice Address - Country:US
Practice Address - Phone:385-465-6452
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-10
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10201002-4405363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily