Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | 26NJ00516800 | NJ |
NPI | 1023418712 |
---|---|
Provider Name | Tiscy Lukose |
First Address | North Brunswick, NJ 08902-4104 |
Second Address | North Brunswick, NJ 08902-4104 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/08/2014 |
Last Update Date | 29/08/2014 |