Healthcare Provider Details

I. General information

NPI: 1538305545
Provider Name (Legal Business Name): MARYANN YUSKO LUKOWICH CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/22/2008
Last Update Date: 07/04/2024
Certification Date: 07/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 E ADAMS ST
COCHRANTON PA
16314-8604
US

IV. Provider business mailing address

1034 GROVE ST
MEADVILLE PA
16335-2945
US

V. Phone/Fax

Practice location:
  • Phone: 814-425-1897
  • Fax: 814-425-9973
Mailing address:
  • Phone: 814-425-1897
  • Fax: 814-425-9973

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberSP010100
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: