Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223D0001X | Dental Public Health | PHDH001108 | PA |
Y | 124Q00000X | Dental Hygienist |
NPI | 1366090862 |
---|---|
Provider Name | Bernadette Lukasik |
First Address | Jermyn, PA 18433-1121 |
Second Address | Jermyn, PA 18433-1121 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/08/2019 |
Last Update Date | 30/10/2019 |