Healthcare Provider Details

I. General information

NPI: 1770001414
Provider Name (Legal Business Name): LUZ R DELUCIA NURSE PRACTITIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2017
Last Update Date: 06/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2578 HEMPSTEAD TPKE
EAST MEADOW NY
11554-2136
US

IV. Provider business mailing address

29 WOODCREST RD
HICKSVILLE NY
11801-6027
US

V. Phone/Fax

Practice location:
  • Phone: 516-333-5555
  • Fax:
Mailing address:
  • Phone: 347-963-3974
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number30924
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: