Provider Demographics
NPI:1518316215
Name:LUKE, TIERRA C
Entity Type:Individual
Prefix:MS
First Name:TIERRA
Middle Name:C
Last Name:LUKE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23555 BRANDYWYNNE ST
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48033-2952
Mailing Address - Country:US
Mailing Address - Phone:313-673-2151
Mailing Address - Fax:
Practice Address - Street 1:23555 BRANDYWYNNE ST
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48033-2952
Practice Address - Country:US
Practice Address - Phone:313-673-2151
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-03
Last Update Date:2016-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other
Provider Identifiers
StateIdentifier IDID TypeIssuer
247200000OtherTECHNICIAN