Provider Demographics
NPI:1255868543
Name:LUCCHESE, GERALDINE (RN)
Entity type:Individual
Prefix:MRS
First Name:GERALDINE
Middle Name:
Last Name:LUCCHESE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MISS
Other - First Name:GERALDINE
Other - Middle Name:
Other - Last Name:LEDAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:100 GLEN ST APT 2514
Mailing Address - Street 2:
Mailing Address - City:GLEN COVE
Mailing Address - State:NY
Mailing Address - Zip Code:11542-2723
Mailing Address - Country:US
Mailing Address - Phone:516-286-5748
Mailing Address - Fax:
Practice Address - Street 1:6 EDEN ROC DR
Practice Address - Street 2:
Practice Address - City:LOCUST VALLEY
Practice Address - State:NY
Practice Address - Zip Code:11560-1117
Practice Address - Country:US
Practice Address - Phone:516-714-0066
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-17
Last Update Date:2017-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY730563163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health