Healthcare Provider Details

I. General information

NPI: 1558337279
Provider Name (Legal Business Name): LUCINDA O CEBULAR CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/23/2006
Last Update Date: 10/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1555 MEDICAL DR
POTTSTOWN PA
19464-3224
US

IV. Provider business mailing address

1555 MEDICAL DR
POTTSTOWN PA
19464-3224
US

V. Phone/Fax

Practice location:
  • Phone: 610-326-7820
  • Fax: 610-326-4068
Mailing address:
  • Phone: 610-326-8720
  • Fax: 610-326-4068

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberUP005560B
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: