Provider Demographics
NPI:1043047855
Name:LU, RAYMOND (DNP)
Entity type:Individual
Prefix:
First Name:RAYMOND
Middle Name:
Last Name:LU
Suffix:
Gender:
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3154 CEDAR GROVE DR
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-1708
Mailing Address - Country:US
Mailing Address - Phone:954-465-4962
Mailing Address - Fax:
Practice Address - Street 1:3154 CEDAR GROVE DR
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-1708
Practice Address - Country:US
Practice Address - Phone:954-465-4962
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-16
Last Update Date:2025-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDAC007254363LP0808X
VA0024191193363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty