Provider Demographics
NPI:1538305545
Name:LUKOWICH, MARYANN YUSKO (CRNP)
Entity type:Individual
Prefix:
First Name:MARYANN
Middle Name:YUSKO
Last Name:LUKOWICH
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1034 GROVE ST
Mailing Address - Street 2:
Mailing Address - City:MEADVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16335-2945
Mailing Address - Country:US
Mailing Address - Phone:814-425-1897
Mailing Address - Fax:814-425-9973
Practice Address - Street 1:104 E ADAMS ST
Practice Address - Street 2:
Practice Address - City:COCHRANTON
Practice Address - State:PA
Practice Address - Zip Code:16314-8604
Practice Address - Country:US
Practice Address - Phone:814-425-1897
Practice Address - Fax:814-425-9973
Is Sole Proprietor?:No
Enumeration Date:2008-12-22
Last Update Date:2024-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP010100363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
PASP010100OtherSTATE LICENSE
PA0007230030001Medicaid
PA393800Medicare Oscar/Certification