MEDICARE: ANNA LUCACI

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
1	164W00000X	Licensed Practical Nurse	333392	NY

General Provider Information

NPI Number	:	1720557788
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANNA LUCACI

Provider Business Mailing Address
First Line	:	1295 86TH ST
Second Line	:
City	:	NIAGARA FALLS
State	:	NY
Zip	:	14304-2503
Country	:	US
Telephone Number	:	716-280-1148
Fax Number	:

Provider Business Practice Location Address
First Line	:	8121 VALLE DR
Second Line	:
City	:	NIAGARA FALLS
State	:	NY
Zip	:	14304-4255
Country	:	US
Telephone Number	:	716-280-1148
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/20/2018
Last Update Date	:	10/11/2024

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