Provider Demographics
NPI:1437403599
Name:LUCKEN, PATRICIA LOUISE (NP)
Entity Type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:LOUISE
Last Name:LUCKEN
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 1:11769 OLD RANCH RD
Mailing Address - Street 2:
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92392-9241
Mailing Address - Country:US
Mailing Address - Phone:760-949-0768
Mailing Address - Fax:
Practice Address - Street 1:15398 MAIN STREET
Practice Address - Street 2:SUITE A
Practice Address - City:HESPERIA
Practice Address - State:CA
Practice Address - Zip Code:92345-3391
Practice Address - Country:US
Practice Address - Phone:176-094-7823
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-28
Last Update Date:2013-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA281290363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily