Individual
NICHOLAS JOHN LUCZEJKO SR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
5501 OLD YORK RD, PHILADELPHIA, PA 19141-3018
(215) 456-7979
Mailing address
1043 FERNON ST, PHILADELPHIA, PA 19148-1107
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
117352
PA
Other
Enumeration date
07/27/2017
Last updated
07/27/2017
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