Provider Demographics
NPI:1205479706
Name:MCKERNAN, LUCY MABEL
Entity type:Individual
Prefix:
First Name:LUCY
Middle Name:MABEL
Last Name:MCKERNAN
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 1:755 HILLSIDE RD
Mailing Address - Street 2:
Mailing Address - City:SEVEN HILLS
Mailing Address - State:OH
Mailing Address - Zip Code:44131-4415
Mailing Address - Country:US
Mailing Address - Phone:216-536-6138
Mailing Address - Fax:
Practice Address - Street 1:755 HILLSIDE RD
Practice Address - Street 2:
Practice Address - City:SEVEN HILLS
Practice Address - State:OH
Practice Address - Zip Code:44131-4415
Practice Address - Country:US
Practice Address - Phone:216-536-6138
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-28
Last Update Date:2019-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist