Healthcare Provider Details

I. General information

NPI: 1891348504
Provider Name (Legal Business Name): DENISE LUCIANO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/22/2019
Last Update Date: 07/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 E LAKE MEAD PKWY APT 2114
HENDERSON NV
89015-6423
US

IV. Provider business mailing address

153 W LAKE MEAD PKWY STE 1220
HENDERSON NV
89015-7046
US

V. Phone/Fax

Practice location:
  • Phone: 224-200-7145
  • Fax:
Mailing address:
  • Phone: 702-566-0665
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: