Healthcare Provider Details

I. General information

NPI: 1841687183
Provider Name (Legal Business Name): ANGELICA SELENA LUCIANO ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2015
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 UNION AVE SE STE 200
OLYMPIA WA
98501-2060
US

IV. Provider business mailing address

3223 S LOOP 289 STE 600
LUBBOCK TX
79423-1372
US

V. Phone/Fax

Practice location:
  • Phone: 833-351-3255
  • Fax: 888-815-3583
Mailing address:
  • Phone: 833-351-8255
  • Fax: 888-815-3583

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberNP95007622
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN60378485
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95007622
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAP60791085
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: