Healthcare Provider Details

I. General information

NPI: 1548619802
Provider Name (Legal Business Name): CATHERINE LUCKIE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2016
Last Update Date: 06/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 GIBNER ROAD SUITE 2
CARLISLE BARRACKS PA
17013
US

IV. Provider business mailing address

450 GIBNER ROAD SUITE 2
CARLISLE BARRACKS PA
17013
US

V. Phone/Fax

Practice location:
  • Phone: 717-245-4542
  • Fax: 717-245-3786
Mailing address:
  • Phone: 717-245-4542
  • Fax: 717-245-3786

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberDHA000197
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: