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General NPI Number Information
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NPI Number | 1659803120
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Entity Type | Organization
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Legal Business Name | ECLUCENTA, INC
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Dates
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Enumeration Date | 04/03/2017
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Last Update Date | 04/03/2017
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Provider Practice Location Address
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Address Line | 10507 E 91ST ST # 560
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City | TULSA
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State | OK
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Zip | 74133-5589
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Country | US
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Telephone | 918-994-5580
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Fax | 918-994-5585
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Provider Business Mailing Address
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Address Line | 10507 E. 91ST # 560
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City | TULSA
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State | OK
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Zip | 74133-5590
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Country | US
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Telephone | 918-994-5580
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Fax | 918-994-5585
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Authorized Official
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Title or Position | OWNER
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Name | MRS. ELIZABETH CATHERINE LUCENTA
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Credential | APRN-CNP
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Telephone | 918-630-5693
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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 | 68962
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License Number State | OK
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