Provider Demographics
NPI:1962461830
Name:LUCKOW, JOYCE MARY (RN)
Entity Type:Individual
Prefix:
First Name:JOYCE
Middle Name:MARY
Last Name:LUCKOW
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 1:1616 HILLCREST DR
Mailing Address - Street 2:
Mailing Address - City:KAUKAUNA
Mailing Address - State:WI
Mailing Address - Zip Code:54130-2940
Mailing Address - Country:US
Mailing Address - Phone:920-766-4035
Mailing Address - Fax:
Practice Address - Street 1:1616 HILLCREST DR
Practice Address - Street 2:
Practice Address - City:KAUKAUNA
Practice Address - State:WI
Practice Address - Zip Code:54130-2940
Practice Address - Country:US
Practice Address - Phone:920-766-4035
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health