Provider Demographics
NPI:1174970974
Name:LUKENS, MARY
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:LUKENS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1126 MISSION RD
Mailing Address - Street 2:
Mailing Address - City:KODIAK
Mailing Address - State:AK
Mailing Address - Zip Code:99615-6540
Mailing Address - Country:US
Mailing Address - Phone:907-486-2654
Mailing Address - Fax:
Practice Address - Street 1:35477 KENAI SPUR HWY STE 203
Practice Address - Street 2:
Practice Address - City:SOLDOTNA
Practice Address - State:AK
Practice Address - Zip Code:99669-7644
Practice Address - Country:US
Practice Address - Phone:907-486-2654
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-21
Last Update Date:2016-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator