Provider Demographics
NPI:1518398288
Name:LUCES, RYAN (LPN)
Entity Type:Individual
Prefix:MRS
First Name:RYAN
Middle Name:
Last Name:LUCES
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MS
Other - First Name:RYAN
Other - Middle Name:
Other - Last Name:RICKETTS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:110 WEST 97TH STREET
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025
Mailing Address - Country:US
Mailing Address - Phone:212-316-7924
Mailing Address - Fax:
Practice Address - Street 1:110 WEST 97TH STREET
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025
Practice Address - Country:US
Practice Address - Phone:212-316-7924
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-12-06
Last Update Date:2013-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY314662164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse