Healthcare Provider Details

I. General information

NPI: 1023541042
Provider Name (Legal Business Name): LIANNE LUCONTONI R,N.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2017
Last Update Date: 04/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 MIDDLESEX AVE
SOMERVILLE MA
02145-1102
US

IV. Provider business mailing address

5 MIDDLESEX AVE
SOMERVILLE MA
02145-1102
US

V. Phone/Fax

Practice location:
  • Phone: 617-665-1566
  • Fax: 617-665-2699
Mailing address:
  • Phone: 617-665-1566
  • Fax: 617-665-2699

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License NumberRN260408
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: