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Individual

BRIANNE MARIE LUCK

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
2813 KENBORG HLS, JEFFERSON CITY, MO 65109-1002
(573) 353-2760
Mailing address
2813 KENBORG HLS, JEFFERSON CITY, MO 65109-1002

Taxonomy

Speciality
Code
Description
License number
State
146N00000X
Basic Emergency Medical Technician
B1775413
TX
156FX1101X
Ophthalmic Assistant
156FX1202X
Optometric Technician
Primary

Other

Enumeration date
08/30/2010
Last updated
08/30/2010
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