Provider Demographics
NPI:1205418753
Name:LUCKETT-CUMMINGS, MONIQUE C (FNP)
Entity type:Individual
Prefix:
First Name:MONIQUE
Middle Name:C
Last Name:LUCKETT-CUMMINGS
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 1:3650 VARIAN AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10466-5935
Mailing Address - Country:US
Mailing Address - Phone:917-371-8441
Mailing Address - Fax:
Practice Address - Street 1:10 WOODS RD
Practice Address - Street 2:
Practice Address - City:VALHALLA
Practice Address - State:NY
Practice Address - Zip Code:10595-1529
Practice Address - Country:US
Practice Address - Phone:917-371-8441
Practice Address - Fax:914-231-1203
Is Sole Proprietor?:No
Enumeration Date:2021-04-24
Last Update Date:2021-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY658951163WC1600X, 363LF0000X
NY348196363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163WC1600XNursing Service ProvidersRegistered NurseContinuing Education/Staff Development
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily