Provider Demographics
NPI:1134451784
Name:LULICH, JOSEPH PETER (FNP-C)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:PETER
Last Name:LULICH
Suffix:
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 47
Mailing Address - Street 2:
Mailing Address - City:MILL CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97360-0047
Mailing Address - Country:US
Mailing Address - Phone:503-897-4100
Mailing Address - Fax:503-897-2673
Practice Address - Street 1:280 S 1ST AVE
Practice Address - Street 2:
Practice Address - City:MILL CITY
Practice Address - State:OR
Practice Address - Zip Code:97360-2324
Practice Address - Country:US
Practice Address - Phone:503-897-4100
Practice Address - Fax:503-897-2673
Is Sole Proprietor?:No
Enumeration Date:2010-02-08
Last Update Date:2020-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201150029363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily