Provider Demographics
NPI:1164045837
Name:LUCCA, JOAN VERN (RN, ANP)
Entity Type:Individual
Prefix:
First Name:JOAN
Middle Name:VERN
Last Name:LUCCA
Suffix:
Gender:F
Credentials:RN, ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 THREE PONDS DR
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:NH
Mailing Address - Zip Code:03833-6659
Mailing Address - Country:US
Mailing Address - Phone:603-548-0811
Mailing Address - Fax:
Practice Address - Street 1:18 THREE PONDS DR
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:NH
Practice Address - Zip Code:03833-6659
Practice Address - Country:US
Practice Address - Phone:603-548-0811
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-28
Last Update Date:2020-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN119032163WX0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WX0200XNursing Service ProvidersRegistered NurseOncology