Provider Demographics
NPI:1801345418
Name:LUCAS-STOKES, CATINA PEBBLES (LPN)
Entity type:Individual
Prefix:
First Name:CATINA
Middle Name:PEBBLES
Last Name:LUCAS-STOKES
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 DEKRUIF PLACE
Mailing Address - Street 2:5B
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10475
Mailing Address - Country:US
Mailing Address - Phone:929-299-8187
Mailing Address - Fax:
Practice Address - Street 1:920 BAYCHESTER AVENUE
Practice Address - Street 2:19B
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10475-1737
Practice Address - Country:US
Practice Address - Phone:929-299-8187
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-23
Last Update Date:2016-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY317003164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse