Provider Demographics
NPI:1912235284
Name:MENAWEJ, LUCIANA MARIA
Entity Type:Individual
Prefix:
First Name:LUCIANA
Middle Name:MARIA
Last Name:MENAWEJ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LUCIANA
Other - Middle Name:MARIA
Other - Last Name:PONTES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:225 SMITH AVE. N.
Mailing Address - Street 2:#500
Mailing Address - City:ST. PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55102
Mailing Address - Country:US
Mailing Address - Phone:651-292-0616
Mailing Address - Fax:651-726-7258
Practice Address - Street 1:225 SMITH AVE. N.
Practice Address - Street 2:#500
Practice Address - City:ST. PAUL
Practice Address - State:MN
Practice Address - Zip Code:55102
Practice Address - Country:US
Practice Address - Phone:651-292-0616
Practice Address - Fax:651-726-7258
Is Sole Proprietor?:No
Enumeration Date:2009-11-25
Last Update Date:2009-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR120030-4163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse