Healthcare Provider Details

I. General information

NPI: 1164338992
Provider Name (Legal Business Name): RACHELLE ANNE LUCERNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/21/2026
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

227 SAINT PAUL ST
BALTIMORE MD
21202-2001
US

IV. Provider business mailing address

227 SAINT PAUL ST
BALTIMORE MD
21202-2001
US

V. Phone/Fax

Practice location:
  • Phone: 410-783-5858
  • Fax: 410-783-5864
Mailing address:
  • Phone: 410-783-5858
  • Fax: 410-783-5864

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR164439
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: