Provider Demographics
NPI:1548962350
Name:LUCYK, LISA
Entity type:Individual
Prefix:MISS
First Name:LISA
Middle Name:
Last Name:LUCYK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1735 EDGEWOOD ST NE
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:OH
Mailing Address - Zip Code:44483-4125
Mailing Address - Country:US
Mailing Address - Phone:330-883-1796
Mailing Address - Fax:
Practice Address - Street 1:1017 INDIANA
Practice Address - Street 2:9
Practice Address - City:NILES
Practice Address - State:OHIO
Practice Address - Zip Code:44484
Practice Address - Country:UM
Practice Address - Phone:330-883-1796
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-17
Last Update Date:2023-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide