=====================================================
General NPI Number Information
=====================================================
NPI Number | 1922059179
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | YVONNE C LUCCA C.R.N.P.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/12/2006
-----------------------------------------------------
Last Update Date | 01/21/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1218 E LANCASTER AVE
-----------------------------------------------------
City | BRYN MAWR
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19010-2616
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 610-519-1920
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 205 MARPLE RD
-----------------------------------------------------
City | HAVERFORD
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19041-1029
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 484-416-3582
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
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 | SP009880
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------