Individual
MR. WAYNE P LUCKENBILL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
2500 BERNVILLE RD, READING, PA 19605-9453
(610) 378-2996
(610) 208-8812
Mailing address
2494 BERNVILLE RD, SUITE 203, READING, PA 19605-9469
(610) 378-2996
(610) 208-8812
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
MA002432L
PA
363AS0400X
Surgical Physician Assistant
OA002527
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
OA002527
LICENSE
PA
Enumeration date
05/21/2010
Last updated
01/08/2016
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