Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207QA0505X | Family Doctor - Adult Medicine | 309081 | NY |
N | 363L00000X | Nurse Practitioner | 309081 | NY |
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 309081 | NY |
NPI | 1346706801 |
---|---|
Provider Name | Rachel Lucente |
First Address | Staten Island, NY 10314-6603 |
Second Address | Staten Island, NY 10310-2507 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/02/2019 |
Last Update Date | 08/10/2020 |