Provider Demographics
NPI:1982363834
Name:LUNA, EVELENE RENE (NP)
Entity Type:Individual
Prefix:
First Name:EVELENE
Middle Name:RENE
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 1:104 PLAZA DR
Mailing Address - Street 2:
Mailing Address - City:RED OAK
Mailing Address - State:TX
Mailing Address - Zip Code:75154-3981
Mailing Address - Country:US
Mailing Address - Phone:972-515-8700
Mailing Address - Fax:214-764-8588
Practice Address - Street 1:104 PLAZA DR
Practice Address - Street 2:
Practice Address - City:RED OAK
Practice Address - State:TX
Practice Address - Zip Code:75154-3981
Practice Address - Country:US
Practice Address - Phone:972-515-8700
Practice Address - Fax:214-764-8588
Is Sole Proprietor?:No
Enumeration Date:2021-12-08
Last Update Date:2021-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1046953363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily