Provider Demographics
NPI:1437201621
Name:LUKAS, HENNY (CNP)
Entity Type:Individual
Prefix:MRS
First Name:HENNY
Middle Name:
Last Name:LUKAS
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:MRS
Other - First Name:HENNY
Other - Middle Name:
Other - Last Name:LUKAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNP, CNS
Mailing Address - Street 1:34960 SPATTERDOCK LN
Mailing Address - Street 2:
Mailing Address - City:SOLON
Mailing Address - State:OH
Mailing Address - Zip Code:44139-5091
Mailing Address - Country:US
Mailing Address - Phone:216-315-9664
Mailing Address - Fax:440-248-4747
Practice Address - Street 1:9900 BREN RD E
Practice Address - Street 2:
Practice Address - City:MINNETONKA
Practice Address - State:MN
Practice Address - Zip Code:55343-9664
Practice Address - Country:US
Practice Address - Phone:216-315-9664
Practice Address - Fax:402-484-7474
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2020-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.295710 COA2163W00000X
OHCOA.08502 NS364S00000X
OHCOA.08604 NP363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
No364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2661856Medicaid