Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | 749590 | TX |
NPI | 1326437849 |
---|---|
Provider Name | Courtney Lynn Lucus |
First Address | Cleburne, TX 76033-8447 |
Second Address | Lewisville, TX 75057-3641 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/01/2015 |
Last Update Date | 06/03/2019 |