Provider Demographics
NPI:1942483557
Name:LUCE, LINDA S (HEALTHCARE PROVIDER)
Entity Type:Individual
Prefix:MISS
First Name:LINDA
Middle Name:S
Last Name:LUCE
Suffix:
Gender:F
Credentials:HEALTHCARE PROVIDER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1223 ELLIS AVE
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43605-3013
Mailing Address - Country:US
Mailing Address - Phone:419-705-0667
Mailing Address - Fax:
Practice Address - Street 1:1223 ELLIS AVE
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43605-3013
Practice Address - Country:US
Practice Address - Phone:419-705-0667
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-06
Last Update Date:2007-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH172V00000X172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2722100Medicaid