Provider Demographics
NPI:1942923198
Name:LUNA, ROBERTO ANTONIO (NP)
Entity Type:Individual
Prefix:
First Name:ROBERTO
Middle Name:ANTONIO
Last Name:LUNA
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:402 W CULVER RD
Mailing Address - Street 2:
Mailing Address - City:KNOX
Mailing Address - State:IN
Mailing Address - Zip Code:46534-2200
Mailing Address - Country:US
Mailing Address - Phone:574-249-6160
Mailing Address - Fax:574-249-6178
Practice Address - Street 1:402 W CULVER RD
Practice Address - Street 2:
Practice Address - City:KNOX
Practice Address - State:IN
Practice Address - Zip Code:46534-2200
Practice Address - Country:US
Practice Address - Phone:574-249-6160
Practice Address - Fax:574-249-6178
Is Sole Proprietor?:No
Enumeration Date:2022-09-22
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71013109A363L00000X
IN28200542A163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse