Provider Demographics
NPI:1164429056
Name:LUCENTE, CHRISTIE J (PA)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTIE
Middle Name:J
Last Name:LUCENTE
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:CHRISTIE
Other - Middle Name:ANN
Other - Last Name:JACOBS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:15 TAVERN RD
Mailing Address - Street 2:
Mailing Address - City:WALTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02453-1634
Mailing Address - Country:US
Mailing Address - Phone:781-209-1212
Mailing Address - Fax:
Practice Address - Street 1:75 FRANCIS ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115-6110
Practice Address - Country:US
Practice Address - Phone:617-732-5500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAAP1828363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant