Provider Demographics
NPI:1174756829
Name:LUCE, DORIS ANN (LPN)
Entity type:Individual
Prefix:MRS
First Name:DORIS
Middle Name:ANN
Last Name:LUCE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MISS
Other - First Name:DORIS
Other - Middle Name:ANN
Other - Last Name:CLARKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8574 SUMAC DR
Mailing Address - Street 2:21-2E
Mailing Address - City:BALDWINSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13027-1468
Mailing Address - Country:US
Mailing Address - Phone:315-720-2105
Mailing Address - Fax:
Practice Address - Street 1:8574 SUMAC DR
Practice Address - Street 2:21-2E
Practice Address - City:BALDWINSVILLE
Practice Address - State:NY
Practice Address - Zip Code:13027-1468
Practice Address - Country:US
Practice Address - Phone:315-720-2105
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-28
Last Update Date:2009-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY294854-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse