Individual
STEPHANIE MARIE LEE LUCKANAVANICH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
AG-ACNP
Contact information
Practice address
5901 E 7TH ST, LONG BEACH, CA 90822-5201
(562) 826-8000
Mailing address
718 RED SAGE, IRVINE, CA 92618-1526
(818) 307-9929
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
Primary
95018256
CA
364SG0600X
Gerontology Clinical Nurse Specialist
95018256
CA
Other
Enumeration date
01/29/2024
Last updated
01/29/2024
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