Provider Demographics
NPI:1497811079
Name:CRONIN, LUCIANNE (FNP,PHD)
Entity Type:Individual
Prefix:DR
First Name:LUCIANNE
Middle Name:
Last Name:CRONIN
Suffix:
Gender:F
Credentials:FNP,PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1645 NASSAU BLVD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28205-3564
Mailing Address - Country:US
Mailing Address - Phone:704-375-5298
Mailing Address - Fax:704-375-6133
Practice Address - Street 1:1006 UNION RD STE D
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-5591
Practice Address - Country:US
Practice Address - Phone:704-810-0006
Practice Address - Fax:704-375-6133
Is Sole Proprietor?:No
Enumeration Date:2006-12-28
Last Update Date:2019-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200959363LP0808X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC80567OtherN.P.
NC200959OtherR.N.
NC6005038Medicaid
NC200959OtherR.N.