Provider Demographics
NPI:1922059179
Name:LUCCA, YVONNE C (CRNP)
Entity Type:Individual
Prefix:MRS
First Name:YVONNE
Middle Name:C
Last Name:LUCCA
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 1:205 MARPLE RD
Mailing Address - Street 2:
Mailing Address - City:HAVERFORD
Mailing Address - State:PA
Mailing Address - Zip Code:19041-1029
Mailing Address - Country:US
Mailing Address - Phone:484-416-3582
Mailing Address - Fax:
Practice Address - Street 1:1218 E LANCASTER AVE
Practice Address - Street 2:
Practice Address - City:BRYN MAWR
Practice Address - State:PA
Practice Address - Zip Code:19010-2616
Practice Address - Country:US
Practice Address - Phone:610-519-1920
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2009-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP009880363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA136636XRUMedicare PIN