Provider Demographics
NPI:1992369912
Name:LUKENBILL, ROXANNE L
Entity Type:Individual
Prefix:MRS
First Name:ROXANNE
Middle Name:L
Last Name:LUKENBILL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:702 S NICHOLS AVE STE 203
Mailing Address - Street 2:
Mailing Address - City:MUNCIE
Mailing Address - State:IN
Mailing Address - Zip Code:47303-5200
Mailing Address - Country:US
Mailing Address - Phone:765-748-5397
Mailing Address - Fax:
Practice Address - Street 1:702 S NICHOLS AVE STE 203
Practice Address - Street 2:
Practice Address - City:MUNCIE
Practice Address - State:IN
Practice Address - Zip Code:47303-5200
Practice Address - Country:US
Practice Address - Phone:765-748-5397
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-24
Last Update Date:2019-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies