Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LA2200X | Nurse Practitioner - Adult Health | 0024169733 | VA |
Y | 363LA2200X | Nurse Practitioner - Adult Health | AC003216 | MD |
NPI | 1023382207 |
---|---|
Provider Name | Mr. Michael Lucrezio |
First Address | Bethesda, MD 20889-0001 |
Second Address | Bethesda, MD 20889-0001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/03/2012 |
Last Update Date | 06/10/2020 |