Provider Demographics
NPI:1841078441
Name:LUCKNER, STACY (LPN)
Entity type:Individual
Prefix:
First Name:STACY
Middle Name:
Last Name:LUCKNER
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 1:707 FOSTER ST
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:OH
Mailing Address - Zip Code:45005-2143
Mailing Address - Country:US
Mailing Address - Phone:513-520-0350
Mailing Address - Fax:
Practice Address - Street 1:707 FOSTER ST
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:OH
Practice Address - Zip Code:45005-2143
Practice Address - Country:US
Practice Address - Phone:513-520-0350
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-15
Last Update Date:2023-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN121921164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse