MEDICARE: MISS LUCINDA JUDITH FAULKNER CRNP

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	363LP0200X	Pediatric Nurse Practitioner	SP009243	PA

General Provider Information

NPI Number	:	1760678916
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS LUCINDA JUDITH FAULKNER CRNP

Provider Business Mailing Address
First Line	:	808 S LAWRENCE ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19147-3113
Country	:	US
Telephone Number	:	267-625-3935
Fax Number	:

Provider Business Practice Location Address
First Line	:	270 COMMRENCE DR
Second Line	:	SUITE 215
City	:	FORT WASHINGTON
State	:	PA
Zip	:	19034-2405
Country	:	US
Telephone Number	:	215-653-0600
Fax Number	:

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

Provider Enumeration Date	:	09/21/2007
Last Update Date	:	09/21/2007

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