Provider Demographics
NPI:1144748815
Name:LUCE, MATTHEW TIMOTHY JAMES
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:TIMOTHY JAMES
Last Name:LUCE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23709A NE 50TH AVE
Mailing Address - Street 2:
Mailing Address - City:BATTLE GROUND
Mailing Address - State:WA
Mailing Address - Zip Code:98604-4070
Mailing Address - Country:US
Mailing Address - Phone:360-901-9788
Mailing Address - Fax:
Practice Address - Street 1:812 OCEAN BEACH HWY STE 200
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:WA
Practice Address - Zip Code:98632-4082
Practice Address - Country:US
Practice Address - Phone:360-636-6900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-01
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN60002190163WE0003X
WAAP60911371363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WE0003XNursing Service ProvidersRegistered NurseEmergency