Provider Demographics
NPI:1851008130
Name:REYES LUNA, JONNATHAN RAMON (FNP)
Entity type:Individual
Prefix:
First Name:JONNATHAN
Middle Name:RAMON
Last Name:REYES LUNA
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:82 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NORTH ANDOVER
Mailing Address - State:MA
Mailing Address - Zip Code:01845-2427
Mailing Address - Country:US
Mailing Address - Phone:351-322-9598
Mailing Address - Fax:978-655-4177
Practice Address - Street 1:25 MARSTON ST APT 105
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:MA
Practice Address - Zip Code:01841-2356
Practice Address - Country:US
Practice Address - Phone:978-258-1057
Practice Address - Fax:978-655-4177
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-04
Last Update Date:2022-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11022777363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL11022777OtherFNP