Provider Demographics
NPI:1306030903
Name:LUCE, EDDA BRIGITTE (LMP)
Entity Type:Individual
Prefix:MRS
First Name:EDDA
Middle Name:BRIGITTE
Last Name:LUCE
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9100 SILVERDALE WAY NW
Mailing Address - Street 2:
Mailing Address - City:SILVERDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98383-8389
Mailing Address - Country:US
Mailing Address - Phone:360-692-1210
Mailing Address - Fax:360-692-1210
Practice Address - Street 1:9100 SILVERDALE WAY NW
Practice Address - Street 2:
Practice Address - City:SILVERDALE
Practice Address - State:WA
Practice Address - Zip Code:98383-8389
Practice Address - Country:US
Practice Address - Phone:360-692-1178
Practice Address - Fax:360-692-1210
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-28
Last Update Date:2007-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00004430174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist