Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156F00000X | Technician/Technologist |
NPI | 1275888927 |
---|---|
Provider Name | Sharon R Luck |
First Address | Fort Worth, TX 76116-7121 |
Second Address | Fort Worth, TX 76116-7121 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/07/2012 |
Last Update Date | 18/07/2012 |