Individual
LUCIANE LORD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
55 FRUIT ST, BOSTON, MA 02114-2621
(617) 724-4100
Mailing address
PO BOX 2699, ATTN: SHMG/HPE, PENSACOLA, FL 32513-2699
(850) 494-9000
(850) 416-1248
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA100119
MA
363AM0700X
Medical Physician Assistant
PA9104319
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2928906-00
—
FL
01
—
Y01K9
BCBS
FL
Enumeration date
09/10/2007
Last updated
11/30/2023
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