Provider Demographics
NPI:1477702371
Name:LUCIER, ANTOINETTA (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:ANTOINETTA
Middle Name:
Last Name:LUCIER
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 HAMPTON STREET
Mailing Address - Street 2:THE VIRGINIA HOUSE
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23220
Mailing Address - Country:US
Mailing Address - Phone:804-359-4093
Mailing Address - Fax:804-358-4075
Practice Address - Street 1:1101 HAMPTON STREET
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23220
Practice Address - Country:US
Practice Address - Phone:804-359-4093
Practice Address - Fax:804-358-4075
Is Sole Proprietor?:No
Enumeration Date:2008-09-16
Last Update Date:2008-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024164921363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner