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NPI Code Detail

MEDICARE: MONIQUE C. LUCKETT-CUMMINGS FNP

MEDICARE:   MONIQUE C. LUCKETT-CUMMINGS  FNP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1163WC1600XContinuing Education/Staff Development Registered Nurse658951NY
2363LF0000XFamily Nurse Practitioner658951NY
3363L00000XNurse Practitioner348196NY

General Provider Information

NPI Number : 1205418753
Entity Type Code : Individual
Provider Name (Legal Business Name) : MONIQUE C. LUCKETT-CUMMINGS FNP
Provider Business Mailing Address
First Line : 3650 VARIAN AVE
Second Line :
City : BRONX
State : NY
Zip : 10466-5935
Country : US
Telephone Number : 917-371-8441
Fax Number :
Provider Business Practice Location Address
First Line : 10 WOODS RD
Second Line :
City : VALHALLA
State : NY
Zip : 10595-1529
Country : US
Telephone Number : 917-371-8441
Fax Number : 914-231-1203
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/24/2021
Last Update Date : 12/12/2021

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