Healthcare Provider Details

I. General information

NPI: 1649559063
Provider Name (Legal Business Name): ALISA HARDY LUKAS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2011
Last Update Date: 07/31/2023
Certification Date: 07/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

345 N MAIN ST STE 112
WEST HARTFORD CT
06117-2508
US

IV. Provider business mailing address

335 PARRISH STREET
CANANDAIGUA NY
14424-1794
US

V. Phone/Fax

Practice location:
  • Phone: 860-236-3000
  • Fax: 860-232-2746
Mailing address:
  • Phone: 585-393-2888
  • Fax: 585-919-2547

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number360551
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2479
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: