Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC0200X | Nurse Practitioner - Critical Care Medicine | NJ00060000 | NJ |
NPI | 1053346262 |
---|---|
Provider Name | Ms. Lauren Michele De Lucia |
First Address | North Bergen, NJ 07047-4024 |
Second Address | North Bergen, NJ 07047-4024 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/07/2006 |
Last Update Date | 10/12/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
Q23636 | (02) |