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General NPI Number Information
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NPI Number | 1508115817
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Entity Type | Individual
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Provider Name | RICHALY LUCE
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Gender | Female
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Dates
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Enumeration Date | 08/31/2012
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Last Update Date | 09/17/2020
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Provider Practice Location Address
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Address Line | 424 S MONROE AVE STE 106
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City | GREEN BAY
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State | WI
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Zip | 54301-4054
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Country | US
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Telephone | 920-544-0346
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Fax | 920-489-8233
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Provider Business Mailing Address
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Address Line | 424 S MONROE AVE STE 106
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City | GREEN BAY
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State | WI
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Zip | 54301-4054
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Country | US
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Telephone | 920-544-0346
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Fax | 920-489-8233
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number | 1003719
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 703436
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License Number State | CA
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