Provider Demographics
NPI:1942394507
Name:LUNA, MARY T (PNP)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:T
Last Name:LUNA
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:
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Mailing Address - Street 1:PO BOX 110429
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80042-0429
Mailing Address - Country:US
Mailing Address - Phone:303-493-7000
Mailing Address - Fax:303-493-7202
Practice Address - Street 1:1056 E 19TH AVE
Practice Address - Street 2:B251
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80218-1007
Practice Address - Country:US
Practice Address - Phone:303-837-2868
Practice Address - Fax:303-764-8694
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2013-01-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO87664363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO56228325Medicaid
CO56228325Medicaid
CO800852Medicare ID - Type Unspecified