Provider Demographics
NPI:1629805130
Name:LUECKE, MATTHEW STEPHEN (FNP-BC)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:STEPHEN
Last Name:LUECKE
Suffix:
Gender:M
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5967 OAK HILL EAST DR
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:IN
Mailing Address - Zip Code:46168-9317
Mailing Address - Country:US
Mailing Address - Phone:317-308-0421
Mailing Address - Fax:
Practice Address - Street 1:5718 CRAWFORDSVILLE RD
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46224-3704
Practice Address - Country:US
Practice Address - Phone:317-240-5501
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-18
Last Update Date:2024-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28248567A163W00000X
IN71015791A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse