Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 176B00000X | Midwife |
NPI | 1063963700 |
---|---|
Provider Name | Carmen Luca |
First Address | Fryeburg, ME 04037-1161 |
Second Address | Fryeburg, ME 04037-1161 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/10/2016 |
Last Update Date | 18/10/2016 |