Healthcare Provider Details

I. General information

NPI: 1942099171
Provider Name (Legal Business Name): STACY LUKER NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/05/2025
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 HOAG DR
NEWPORT BEACH CA
92663-4162
US

IV. Provider business mailing address

2 HIDDEN CREEK LN
LAGUNA HILLS CA
92653-4478
US

V. Phone/Fax

Practice location:
  • Phone: 949-764-5350
  • Fax: 949-764-8557
Mailing address:
  • Phone: 714-397-8201
  • Fax: 714-397-8201

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberNP95030723
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: