Provider Demographics
NPI:1992358576
Name:LAMOTHE, LUCIENNE (FNP)
Entity Type:Individual
Prefix:
First Name:LUCIENNE
Middle Name:
Last Name:LAMOTHE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 QUINCY AVE
Mailing Address - Street 2:
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02302-2864
Mailing Address - Country:US
Mailing Address - Phone:774-223-7897
Mailing Address - Fax:954-405-8874
Practice Address - Street 1:225 QUINCY AVE
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02302-2864
Practice Address - Country:US
Practice Address - Phone:774-223-7897
Practice Address - Fax:954-405-8874
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-22
Last Update Date:2023-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2259797163W00000X, 163WG0000X, 363LF0000X
MAF10190728363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice