Provider Demographics
NPI:1568645141
Name:CRIMINALE, LUCCA (PA-C)
Entity Type:Individual
Prefix:MS
First Name:LUCCA
Middle Name:
Last Name:CRIMINALE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:817 COMMERCIAL STREET
Mailing Address - Street 2:
Mailing Address - City:LEAVENWORTH
Mailing Address - State:WA
Mailing Address - Zip Code:98826-1316
Mailing Address - Country:US
Mailing Address - Phone:509-548-3431
Mailing Address - Fax:509-548-2510
Practice Address - Street 1:817 COMMERCIAL ST
Practice Address - Street 2:
Practice Address - City:LEAVENWORTH
Practice Address - State:WA
Practice Address - Zip Code:98826-1316
Practice Address - Country:US
Practice Address - Phone:509-548-5815
Practice Address - Fax:509-548-2510
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-06
Last Update Date:2022-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA10005333363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA449912OtherDEPARTMENT OF LABOR & INDUSTRIES
WA244043OtherDEPARTMENT OF LABOR & INDUSTRIES
WA8501439Medicaid