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Individual

CARYL MARIE LUCKETT

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
RN

Contact information

Practice address
456 GROS VENTRE AVE, HARELM, MT 59526
(406) 353-3100
Mailing address
RR 1 BOX 67, HARLEM, MT 59526-9705
(406) 353-3100

Taxonomy

Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
4625
MT

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
4625
LICENSE
MT
Enumeration date
12/03/2008
Last updated
12/03/2008
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