Provider Demographics
NPI:1497986301
Name:LUKEZ, SHANNON NOEL (ARNP-BC)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:NOEL
Last Name:LUKEZ
Suffix:
Gender:F
Credentials:ARNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2195 CHEAT RD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26508-0022
Mailing Address - Country:US
Mailing Address - Phone:304-594-0456
Mailing Address - Fax:304-594-3249
Practice Address - Street 1:2195 CHEAT RD
Practice Address - Street 2:SUITE 2
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26508-0022
Practice Address - Country:US
Practice Address - Phone:304-594-0456
Practice Address - Fax:304-594-3249
Is Sole Proprietor?:No
Enumeration Date:2009-07-28
Last Update Date:2015-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA10804NP363LA2200X
WVAPRN85183-ANP-BC363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NP31401Medicare PIN