Provider Demographics
NPI:1780911248
Name:LUCKY, DANIEL S (MSN, FNP-C, GNP-C,)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:S
Last Name:LUCKY
Suffix:
Gender:M
Credentials:MSN, FNP-C, GNP-C,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 E RUMBLE RD
Mailing Address - Street 2:SUITE E
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95350-2356
Mailing Address - Country:US
Mailing Address - Phone:209-527-7777
Mailing Address - Fax:
Practice Address - Street 1:2501 MCHENRY AVE
Practice Address - Street 2:SUITE F
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95350-3259
Practice Address - Country:US
Practice Address - Phone:209-522-9054
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-11-04
Last Update Date:2009-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19377363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily