Provider Demographics
NPI:1538218482
Name:CERALDI, LUCY (RN, CNOR , CRNFA)
Entity type:Individual
Prefix:
First Name:LUCY
Middle Name:
Last Name:CERALDI
Suffix:
Gender:F
Credentials:RN, CNOR , CRNFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2910 WHETSTONE LN
Mailing Address - Street 2:
Mailing Address - City:EULESS
Mailing Address - State:TX
Mailing Address - Zip Code:76039-4114
Mailing Address - Country:US
Mailing Address - Phone:817-366-2804
Mailing Address - Fax:817-540-2503
Practice Address - Street 1:2910 WHETSTONE LN
Practice Address - Street 2:
Practice Address - City:EULESS
Practice Address - State:TX
Practice Address - Zip Code:76039-4114
Practice Address - Country:US
Practice Address - Phone:817-366-2804
Practice Address - Fax:817-540-2503
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX581823163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX89N951 GROUP # 66HTOtherBCBS
TXCCP108328Medicaid