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General NPI Number Information
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NPI Number | 1609015510
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Entity Type | Individual
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Provider Name | ANNE B. LUCKOSE APN, NP-C
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Gender | Female
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Dates
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Enumeration Date | 02/17/2009
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Last Update Date | 01/18/2013
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Provider Practice Location Address
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Address Line | 1052 W. LOYOLA AVENUE
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City | CHICAGO
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State | IL
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Zip | 60626
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Country | US
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Telephone | 773-508-2540
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Fax | 773-508-2242
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Provider Business Mailing Address
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Address Line | 1052 W LOYOLA AVE
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City | CHICAGO
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State | IL
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Zip | 60626-5206
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Country | US
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Telephone | 773-508-2540
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Fax | 773-508-2242
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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 | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 041340115
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License Number State | IL
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