Healthcare Provider Details

I. General information

NPI: 1760578116
Provider Name (Legal Business Name): NANCY CAROL LUCKIE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 01/22/2025
Certification Date: 01/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1188 BISHOP ST STE 2702
HONOLULU HI
96813-3311
US

IV. Provider business mailing address

1330 ALA MOANA BLVD APT 2204
HONOLULU HI
96814-4230
US

V. Phone/Fax

Practice location:
  • Phone: 808-955-7372
  • Fax: 808-951-9282
Mailing address:
  • Phone: 808-955-7372
  • Fax: 808-951-9282

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number5344
License Number StateHI
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD-5344
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: