Individual
JESSICA G LUCKENBILL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
9000 N MAIN ST, SUITE 200, ENGLEWOOD, OH 45415-1180
(937) 836-5555
(937) 836-7518
Mailing address
9000 N MAIN ST, SUITE 200, ENGLEWOOD, OH 45415-1180
(937) 836-5555
(937) 836-7518
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
50.003591
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0074453
—
OH
Enumeration date
09/18/2012
Last updated
07/11/2015
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