1295826477 NPI number — MRS. ANGELA PATRICIA LUKOMSKI CPNP

Table of content: MRS. ANGELA PATRICIA LUKOMSKI CPNP (NPI 1295826477)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295826477 NPI number — MRS. ANGELA PATRICIA LUKOMSKI CPNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LUKOMSKI
Provider First Name:
ANGELA
Provider Middle Name:
PATRICIA
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
CPNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BAKER
Provider Other First Name:
ANGELA
Provider Other Middle Name:
PATRICIA
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
CPNP
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1295826477
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/10/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
23133 ORCHARD LAKE RD
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
FARMINGTON
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48336-3268
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
248-477-0100
Provider Business Mailing Address Fax Number:
248-477-6153

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
23133 ORCHARD LAKE RD
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
FARMINGTON
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48336-3268
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
248-477-0100
Provider Business Practice Location Address Fax Number:
248-477-6153
Provider Enumeration Date:
09/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 163WP0200X , with the licence number:  4704195194 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LP0200X , with the licence number: 4704195194 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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