Provider Demographics
NPI:1912360397
Name:HUANG, LUTSIYA (NP)
Entity Type:Individual
Prefix:
First Name:LUTSIYA
Middle Name:
Last Name:HUANG
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:LUTSIYA
Other - Middle Name:
Other - Last Name:IMBRAGIMOVA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1637 MINERAL SPRING AVE
Mailing Address - Street 2:SUITE 107
Mailing Address - City:NORTH PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02904-4042
Mailing Address - Country:US
Mailing Address - Phone:401-354-4400
Mailing Address - Fax:401-354-4474
Practice Address - Street 1:1637 MINERAL SPRING AVE
Practice Address - Street 2:STE 107
Practice Address - City:NORTH PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02904-4042
Practice Address - Country:US
Practice Address - Phone:401-354-4400
Practice Address - Fax:401-354-4474
Is Sole Proprietor?:No
Enumeration Date:2016-04-01
Last Update Date:2017-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIAPRN00892363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily