Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LG0600X | Nurse Practitioner - Gerontology | 2021028732 | MO |
N | 363LG0600X | Nurse Practitioner - Gerontology | 28220633A | IN |
NPI | 1083135909 |
---|---|
Provider Name | Lingxiao Lu |
First Address | Saint Louis, MO 63141-8221 |
Second Address | Saint Louis, MO 63141-8221 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/06/2017 |
Last Update Date | 25/08/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
300005862 | (05) | IN |
M47140291 | MEDICARE (01) | IN |