Individual
TIMOTHY ROBERT LUCISANO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
10628 PARK RD, ANESTHESIA DEPARTMENT, CHARLOTTE, NC 28210-8407
(704) 667-1000
Mailing address
10628 PARK RD, ANESTHESIA DEPARTMENT, CHARLOTTE, NC 28210-8407
(704) 667-1971
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
102492
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8051806
—
NC
05
—
NAN635
—
SC
Enumeration date
06/28/2006
Last updated
08/14/2008
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