Provider Demographics
NPI:1295826477
Name:LUKOMSKI, ANGELA PATRICIA (CPNP)
Entity Type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:PATRICIA
Last Name:LUKOMSKI
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:MISS
Other - First Name:ANGELA
Other - Middle Name:PATRICIA
Other - Last Name:BAKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CPNP
Mailing Address - Street 1:23133 ORCHARD LAKE RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:FARMINGTON
Mailing Address - State:MI
Mailing Address - Zip Code:48336-3268
Mailing Address - Country:US
Mailing Address - Phone:248-477-0100
Mailing Address - Fax:248-477-6153
Practice Address - Street 1:23133 ORCHARD LAKE RD
Practice Address - Street 2:SUITE 100
Practice Address - City:FARMINGTON
Practice Address - State:MI
Practice Address - Zip Code:48336-3268
Practice Address - Country:US
Practice Address - Phone:248-477-0100
Practice Address - Fax:248-477-6153
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2013-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704195194163WP0200X, 363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No163WP0200XNursing Service ProvidersRegistered NursePediatrics