Healthcare Provider Details

I. General information

NPI: 1366751216
Provider Name (Legal Business Name): LUCIA ANNE YU RN; BSN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LUCIA ANNE COLE RN; BSN

II. Dates (important events)

Enumeration Date: 09/27/2010
Last Update Date: 09/27/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2140 E ELLSWORTH RD
ANN ARBOR MI
48108-2552
US

IV. Provider business mailing address

555 TOWNER ST PO. BOX 915
YPSILANTI MI
48198-5752
US

V. Phone/Fax

Practice location:
  • Phone: 734-222-3567
  • Fax: 734-222-3461
Mailing address:
  • Phone: 734-544-3000
  • Fax: 734-544-6732

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number4704205682
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: