Organization
SUMMERSVILLE SKIN CARE CENTER INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DELORES A LUCKY RNC-FNP (NURSE PRACTITIONER)
(304) 872-3654
Entity
Organization
Contact information
Practice address
818 ARBUCKLE RD, SUMMERSVILLE, WV 26651-1704
(304) 872-3654
Mailing address
818 ARBUCKLE RD, SUMMERSVILLE, WV 26651-1704
(304) 872-3654
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
44396
WV
Other
Enumeration date
11/28/2006
Last updated
07/21/2011
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