Provider Demographics
NPI:1346799475
Name:LUCE, KATELYNE (LPN)
Entity Type:Individual
Prefix:MRS
First Name:KATELYNE
Middle Name:
Last Name:LUCE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2400 2ND AVE APT 520
Mailing Address - Street 2:
Mailing Address - City:WATERVLIET
Mailing Address - State:NY
Mailing Address - Zip Code:12189-2250
Mailing Address - Country:US
Mailing Address - Phone:518-268-3569
Mailing Address - Fax:
Practice Address - Street 1:2400 2ND AVE APT 520
Practice Address - Street 2:
Practice Address - City:WATERVLIET
Practice Address - State:NY
Practice Address - Zip Code:12189-2250
Practice Address - Country:US
Practice Address - Phone:518-268-3569
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-30
Last Update Date:2016-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY323770164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse