MEDICARE: MRS. RENA KATHLENE LUKASIK PA

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	171000000X	Military Health Care Provider	PA04260	TX
2	363A00000X	Physician Assistant	PA04260	TX

General Provider Information

NPI Number	:	1932246147
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. RENA KATHLENE LUKASIK PA

Provider Business Mailing Address
First Line	:	18511 HIGHLANDER MEDICS ST
Second Line	:
City	:	FORT BLISS
State	:	TX
Zip	:	79906-5327
Country	:	US
Telephone Number	:	915-742-0847
Fax Number	:

Provider Business Practice Location Address
First Line	:	SFMC RICKER RD
Second Line	:	BLDG 2496
City	:	FT BLISS
State	:	TX
Zip	:	79916
Country	:	US
Telephone Number	:	915-568-3088
Fax Number	:

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

Provider Enumeration Date	:	01/30/2007
Last Update Date	:	02/26/2024

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