Healthcare Provider Details

I. General information

NPI: 1669705307
Provider Name (Legal Business Name): KAZIMIERA MARSH LUCE FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2009
Last Update Date: 06/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15425 LOS GATOS BLVD STE 101
LOS GATOS CA
95032
US

IV. Provider business mailing address

15425 LOS GATOS BLVD SUITE 101
LOS GATOS CA
95032-0259
US

V. Phone/Fax

Practice location:
  • Phone: 408-354-3920
  • Fax: 408-354-0782
Mailing address:
  • Phone: 408-354-3920
  • Fax: 408-354-0782

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number19330
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: