Provider Demographics
NPI:1740542406
Name:ANKRAH, LUCY (APN)
Entity type:Individual
Prefix:MRS
First Name:LUCY
Middle Name:
Last Name:ANKRAH
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:137 EVERGREEN PL STE 1B
Mailing Address - Street 2:
Mailing Address - City:EAST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07018-2007
Mailing Address - Country:US
Mailing Address - Phone:917-535-7086
Mailing Address - Fax:862-367-7835
Practice Address - Street 1:137 EVERGREEN PL STE 1B
Practice Address - Street 2:
Practice Address - City:EAST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07018-2007
Practice Address - Country:US
Practice Address - Phone:917-535-7086
Practice Address - Fax:862-367-7835
Is Sole Proprietor?:No
Enumeration Date:2012-06-08
Last Update Date:2024-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00379600363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0300187Medicaid