Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2100X | Nurse Practitioner - Acute Care | 201450 | OK |
NPI | 1033704168 |
---|---|
Provider Name | Derrick Lugano |
First Address | Tulsa, OK 74133-5829 |
Second Address | Tulsa, OK 74133-5829 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/03/2021 |
Last Update Date | 01/03/2021 |