Healthcare Provider Details

I. General information

NPI: 1205411634
Provider Name (Legal Business Name): DANIELLE MARIE LUCCHESE FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/17/2021
Last Update Date: 05/02/2023
Certification Date: 05/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 CORPORATE PARK DR STE 200&300
MOORESVILLE NC
28117-7133
US

IV. Provider business mailing address

PO BOX 60447
CHARLOTTE NC
28260-0447
US

V. Phone/Fax

Practice location:
  • Phone: 704-235-9090
  • Fax: 704-235-9101
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number5015993
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: