Provider Demographics
NPI:1841978814
Name:LUCES, CORDELLE ANDARIO
Entity type:Individual
Prefix:
First Name:CORDELLE
Middle Name:ANDARIO
Last Name:LUCES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:71 BENTWOOD DR APT 12
Mailing Address - Street 2:
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06705-3617
Mailing Address - Country:US
Mailing Address - Phone:646-750-1044
Mailing Address - Fax:
Practice Address - Street 1:71 BENTWOOD DR APT 12
Practice Address - Street 2:
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06705-3617
Practice Address - Country:US
Practice Address - Phone:646-750-1044
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-10
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY751964163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse