Healthcare Provider Details

I. General information

NPI: 1487216073
Provider Name (Legal Business Name): ROSELAURE LUCA FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2019
Last Update Date: 07/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 BRYANT PARK 5TH FLOOR
NEW YORK NY
10018
US

IV. Provider business mailing address

838 PELHAMDALE AVE APT 1H
NEW ROCHELLE NY
10801-1014
US

V. Phone/Fax

Practice location:
  • Phone: 917-780-4930
  • Fax:
Mailing address:
  • Phone: 518-569-8223
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number9643059
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: