Provider Demographics
NPI:1730921743
Name:LUJAN, DIANE (CPNP)
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:
Last Name:LUJAN
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10755 KENWORTHY ST
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79924-1717
Mailing Address - Country:US
Mailing Address - Phone:915-821-5900
Mailing Address - Fax:915-821-5902
Practice Address - Street 1:10755 KENWORTHY ST
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79924-1717
Practice Address - Country:US
Practice Address - Phone:915-821-5900
Practice Address - Fax:915-821-5902
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-10
Last Update Date:2024-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1165342363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatricsGroup - Single Specialty