MEDICARE: REBECCA L LUCKE CRNA

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	367500000X	Certified Registered Nurse Anesthetist	54337	KS

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	430023314	OTHER		RR MEDICARE GROUP CK2307

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	043045	OTHER	KS	BCBS

General Provider Information

NPI Number	:	1801888094
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REBECCA L LUCKE CRNA

Provider Business Mailing Address
First Line	:	5135 N HARBORSIDE CT
Second Line	:
City	:	WICHITA
State	:	KS
Zip	:	67204-2370
Country	:	US
Telephone Number	:	316-258-1948
Fax Number	:

Provider Business Practice Location Address
First Line	:	5135 N HARBORSIDE CT
Second Line	:
City	:	WICHITA
State	:	KS
Zip	:	67204-2370
Country	:	US
Telephone Number	:	316-258-1948
Fax Number	:

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

Provider Enumeration Date	:	08/16/2005
Last Update Date	:	08/20/2012

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Directions to “ REBECCA L LUCKE CRNA” Practice Location

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