Healthcare Provider Details

I. General information

NPI: 1992554729
Provider Name (Legal Business Name): DANIELLE NICOLE LUKES PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/14/2024
Last Update Date: 06/18/2024
Certification Date: 06/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3567 RESERVE COMMONS DR
MEDINA OH
44256-5323
US

IV. Provider business mailing address

1362 W 59TH ST
CLEVELAND OH
44102-2102
US

V. Phone/Fax

Practice location:
  • Phone: 330-536-3746
  • Fax:
Mailing address:
  • Phone: 440-591-4937
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number476693
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number0036677
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: