Individual
RYAN LUECK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NP
Contact information
Practice address
3801 S NATIONAL AVE, SUITE 900, SPRINGFIELD, MO 65807-5210
(417) 875-3087
(417) 875-2822
Mailing address
PO BOX 9007, SPRINGFIELD, MO 65808-9007
(417) 875-3000
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
2016029747
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1871041566
—
MO
05
—
420037004
—
MO
Enumeration date
09/12/2016
Last updated
12/27/2018
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