Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207PE0004X | Emergency Medical Services | 21734 | TN |
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | 21734 | TN |
NPI | 1073266219 |
---|---|
Provider Name | Gina Marie Lucchesi |
First Address | Arlington, TN 38002-7940 |
Second Address | Germantown, TN 38138-1785 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/01/2022 |
Last Update Date | 28/01/2022 |