Individual
ANNEICA LUCKETT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
515 BENSLEY AVE, CALUMET CITY, IL 60409-3203
(414) 405-4072
Mailing address
515 BENSLEY AVE, CALUMET CITY, IL 60409-3203
(414) 405-4072
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
308967
WI
Other
Enumeration date
09/23/2015
Last updated
09/23/2015
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