Individual
REBECCA L LUCKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
5135 N HARBORSIDE CT, WICHITA, KS 67204-2370
(316) 258-1948
Mailing address
5135 N HARBORSIDE CT, WICHITA, KS 67204-2370
(316) 258-1948
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
54337
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
043045
BCBS
KS
05
—
100252910A
—
KS
05
—
100252910E
—
KS
01
—
430023314
RR MEDICARE GROUP CK2307
—
Enumeration date
08/16/2005
Last updated
08/20/2012
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