Provider Demographics
NPI:1770810715
Name:LUONG, PRISCILLA MARIE (NP)
Entity type:Individual
Prefix:MS
First Name:PRISCILLA
Middle Name:MARIE
Last Name:LUONG
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 1:5602 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85205-8813
Mailing Address - Country:US
Mailing Address - Phone:480-854-9004
Mailing Address - Fax:480-832-1858
Practice Address - Street 1:5602 E MAIN ST
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85205-8813
Practice Address - Country:US
Practice Address - Phone:480-854-9004
Practice Address - Fax:480-832-1858
Is Sole Proprietor?:No
Enumeration Date:2009-11-12
Last Update Date:2010-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP3452363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care