Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080A0000X | Adolescent Medicine | 29596 | KY |
NPI | 1083702062 |
---|---|
Provider Name | Arlyn E. Lua-Canby |
First Address | Chicago, IL 60677-6351 |
Second Address | Shelbyville, KY 40065-9433 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/10/2006 |
Last Update Date | 19/01/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F47237 | (02) | KY |