Healthcare Provider Details

I. General information

NPI: 1699042929
Provider Name (Legal Business Name): LUCHINA M MOXLEY RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2011
Last Update Date: 12/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 MAIN ST
BUFFALO NY
14202-1102
US

IV. Provider business mailing address

1010 MAIN ST
BUFFALO NY
14202-1102
US

V. Phone/Fax

Practice location:
  • Phone: 716-859-4791
  • Fax: 716-859-4858
Mailing address:
  • Phone: 716-859-4791
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number556705
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: