Individual
JOAN MARIE LUCKEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN,BC
Contact information
Practice address
109 E ELM ST, STREATOR, IL 61364-2223
(815) 672-4587
(815) 673-3582
Mailing address
109 E ELM ST, STREATOR, IL 61364-2223
(815) 672-4587
(815) 673-3582
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
209-001759
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
209-001759
STATE LICENSE NUMBER
IL
Enumeration date
11/16/2006
Last updated
03/10/2011
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