Provider Demographics
NPI:1760678916
Name:FAULKNER, LUCINDA JUDITH (CRNP)
Entity Type:Individual
Prefix:MISS
First Name:LUCINDA
Middle Name:JUDITH
Last Name:FAULKNER
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:808 S LAWRENCE ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19147-3113
Mailing Address - Country:US
Mailing Address - Phone:267-625-3935
Mailing Address - Fax:
Practice Address - Street 1:270 COMMRENCE DR
Practice Address - Street 2:SUITE 215
Practice Address - City:FORT WASHINGTON
Practice Address - State:PA
Practice Address - Zip Code:19034-2405
Practice Address - Country:US
Practice Address - Phone:215-653-0600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-21
Last Update Date:2007-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP009243363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics