Individual
MS. ALA BIANCA NAOMI LUCKY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
2001 LAUREL ST, COLUMBIA, SC 29204-1018
(803) 254-3278
(803) 929-3256
Mailing address
PO BOX 935722, ATLANTA, GA 31193-5722
(843) 792-6200
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
21969
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
NP5843
—
SC
Enumeration date
06/27/2018
Last updated
08/25/2021
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