Provider Demographics
NPI:1174269534
Name:LUKASEWYCZ, HEATHER ALYSSA (NP)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:ALYSSA
Last Name:LUKASEWYCZ
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:JACK
Other - Middle Name:
Other - Last Name:LUKASEWYCZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NP
Mailing Address - Street 1:160 NW FRANKLIN BLVD
Mailing Address - Street 2:
Mailing Address - City:GRANTS PASS
Mailing Address - State:OR
Mailing Address - Zip Code:97526-1086
Mailing Address - Country:US
Mailing Address - Phone:541-344-9411
Mailing Address - Fax:
Practice Address - Street 1:160 NW FRANKLIN BLVD
Practice Address - Street 2:
Practice Address - City:GRANTS PASS
Practice Address - State:OR
Practice Address - Zip Code:97526-1086
Practice Address - Country:US
Practice Address - Phone:541-344-9411
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-09
Last Update Date:2022-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR202204137NP363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health