Individual
GENNELLE KATHERINE LUCID
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-BC
Contact information
Practice address
2030 CHURCHMAN AVE, BEECH GROVE, IN 46107-1044
(317) 786-9285
(317) 781-2793
Mailing address
PO BOX 781076, DETROIT, MI 48278-1076
(317) 528-4800
(317) 865-1479
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
71004017A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201091130
—
IN
Enumeration date
05/03/2012
Last updated
05/18/2023
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