Provider Demographics
NPI:1053346262
Name:DE LUCIA, LAUREN MICHELE (APN)
Entity type:Individual
Prefix:MS
First Name:LAUREN
Middle Name:MICHELE
Last Name:DE LUCIA
Suffix:
Gender:F
Credentials:APN
Other - Prefix:MS
Other - First Name:LAUREN
Other - Middle Name:MICHELE
Other - Last Name:DE LUCIA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:APN
Mailing Address - Street 1:7617 KENNEDY BLVD
Mailing Address - Street 2:
Mailing Address - City:NORTH BERGEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07047-4024
Mailing Address - Country:US
Mailing Address - Phone:201-854-1500
Mailing Address - Fax:201-854-1505
Practice Address - Street 1:7617 KENNEDY BLVD
Practice Address - Street 2:
Practice Address - City:NORTH BERGEN
Practice Address - State:NJ
Practice Address - Zip Code:07047-4024
Practice Address - Country:US
Practice Address - Phone:201-854-1500
Practice Address - Fax:201-854-1505
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJNJ00060000363LC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LC0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ083028Medicare ID - Type Unspecified
Q23636Medicare UPIN