=====================================================
General NPI Number Information
=====================================================
NPI Number | 1265172191
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JOANA LUKASIK FNP-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/30/2022
-----------------------------------------------------
Last Update Date | 08/28/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4141 SHIPYARD BLVD
-----------------------------------------------------
City | WILMINGTON
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28403-6156
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 910-792-9925
-----------------------------------------------------
Fax | 910-792-9926
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1202 MEDICAL CENTER DR
-----------------------------------------------------
City | WILMINGTON
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28401-7307
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 910-341-1540
-----------------------------------------------------
Fax | 910-431-4048
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | F01220957
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number | 5015917
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------