Provider Demographics
NPI:1407613136
Name:KALAS-LUKIC, MARIJA (NP)
Entity Type:Individual
Prefix:
First Name:MARIJA
Middle Name:
Last Name:KALAS-LUKIC
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 CLAIRE RD
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13214-1907
Mailing Address - Country:US
Mailing Address - Phone:315-412-9510
Mailing Address - Fax:
Practice Address - Street 1:725 E ADAMS ST STE 3A
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13210-2576
Practice Address - Country:US
Practice Address - Phone:315-464-6527
Practice Address - Fax:315-464-6529
Is Sole Proprietor?:No
Enumeration Date:2024-02-29
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF353099363L00000X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner