Individual
DONNA LEE LUCKETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1118 TEMPLE ST SE, GRAND RAPIDS, MI 49507-1967
(616) 295-6582
Mailing address
1118 TEMPLE ST SE, GRAND RAPIDS, MI 49507-1967
(616) 295-6582
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
4704217517
MI
Other
Enumeration date
03/14/2019
Last updated
03/14/2019
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