Individual
GAIL S LUKASIEWICZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
610 N MICHIGAN ST, SUITE 400, SOUTH BEND, IN 46601-1077
(574) 647-8120
(574) 647-8111
Mailing address
3355 DOUGLAS RD, SUITE 300, SOUTH BEND, IN 46635-1781
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
71001252A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200411050
—
IN
01
—
257270B
MEDICARE PTAN
IN
Enumeration date
10/26/2005
Last updated
02/19/2009
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