Healthcare Provider Details

I. General information

NPI: 1184198244
Provider Name (Legal Business Name): RICHARD LUCKHURST LVN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/11/2019
Last Update Date: 01/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3133 N MILLBROOK AVE
FRESNO CA
93703-1425
US

IV. Provider business mailing address

1431 N VOLTERRA CT
VISALIA CA
93291-9792
US

V. Phone/Fax

Practice location:
  • Phone: 559-600-8918
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License NumberVN148634
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: