Provider Demographics
NPI:1922414085
Name:TANAKA, LUCIA (RN)
Entity Type:Individual
Prefix:
First Name:LUCIA
Middle Name:
Last Name:TANAKA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 MADISON AVE FL 5
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10010-1600
Mailing Address - Country:US
Mailing Address - Phone:212-545-2438
Mailing Address - Fax:646-312-0481
Practice Address - Street 1:150 ESSEX ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10002-2301
Practice Address - Country:US
Practice Address - Phone:212-477-1120
Practice Address - Fax:212-477-8957
Is Sole Proprietor?:No
Enumeration Date:2014-07-09
Last Update Date:2015-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95024245163W00000X
NY672475163W00000X
NYF339360363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00695941Medicaid
NY331043Medicare Oscar/Certification
NY331058Medicare Oscar/Certification
NY331943Medicare Oscar/Certification
NY00695941Medicaid
NY331978Medicare Oscar/Certification
NY331952Medicare Oscar/Certification
NY331944Medicare Oscar/Certification
NY331946Medicare Oscar/Certification
NY331947Medicare Oscar/Certification
NY331954Medicare Oscar/Certification
NYW6L111Medicare Oscar/Certification
NY331945Medicare Oscar/Certification
NYG100000410Medicare Oscar/Certification