Provider Demographics
NPI:1871868281
Name:LUKE, MARY JEAN (CNS)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:JEAN
Last Name:LUKE
Suffix:
Gender:F
Credentials:CNS
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:JEAN
Other - Last Name:WHITE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNS
Mailing Address - Street 1:PO BOX 715385
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43271-5385
Mailing Address - Country:US
Mailing Address - Phone:440-879-0081
Mailing Address - Fax:440-879-0084
Practice Address - Street 1:400 WABASH AVE
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44307-2433
Practice Address - Country:US
Practice Address - Phone:330-344-6000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-19
Last Update Date:2012-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHNS-09833364SA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SA2100XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAcute Care