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General NPI Number Information
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NPI Number | 1588071179
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Entity Type | Individual
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Provider Name | LICHELLE NUCUM LUM N.P.
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Gender | Female
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Dates
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Enumeration Date | 07/16/2014
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Last Update Date | 10/22/2014
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Provider Practice Location Address
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Address Line | 100 HOSPITAL DR STE 110
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City | VALLEJO
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State | CA
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Zip | 94589-2577
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Country | US
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Telephone | 707-551-3300
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Fax | 707-551-3301
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Provider Business Mailing Address
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Address Line | 100 HOSPITAL DR STE 110
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City | VALLEJO
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State | CA
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Zip | 94589-2577
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Country | US
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Telephone | 707-551-3300
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Fax | 707-551-3301
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 95000924
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License Number State | CA
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