Individual
CARMEN LUCKETT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
7458 W 64TH PL, SUMMIT, IL 60501-1922
(773) 727-4855
Mailing address
7458 W 64TH PL, SUMMIT, IL 60501-1922
(773) 727-4855
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
043109504
IA
Other
Enumeration date
10/04/2021
Last updated
10/04/2021
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