Individual
AMANDA R LUNA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
6609 W GREENFIELD AVE, WEST ALLIS, WI 53214-4958
(414) 257-8500
(414) 257-8505
Mailing address
PO BOX 735044, CHICAGO, IL 60673-5044
(800) 326-2250
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
3871-23
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100060413
—
WI
05
—
1043768658
—
WI
Enumeration date
09/13/2016
Last updated
10/17/2024
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