Healthcare Provider Details

I. General information

NPI: 1922166859
Provider Name (Legal Business Name): GAIA E LUKEVICH RNFA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/04/2006
Last Update Date: 01/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19930 BALLINGER WAY NE
SHORELINE WA
98155-1223
US

IV. Provider business mailing address

19930 BALLINGER WAY NE
SHORELINE WA
98155-1223
US

V. Phone/Fax

Practice location:
  • Phone: 425-778-2220
  • Fax:
Mailing address:
  • Phone: 257-782-2204
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License NumberRN00148940
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: