Provider Demographics
NPI:1609180033
Name:LUKUSA, HEATHER NICOLE (DNP)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:NICOLE
Last Name:LUKUSA
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:685 MORRO AVE STE C
Mailing Address - Street 2:
Mailing Address - City:MORRO BAY
Mailing Address - State:CA
Mailing Address - Zip Code:93442-2233
Mailing Address - Country:US
Mailing Address - Phone:805-772-7313
Mailing Address - Fax:
Practice Address - Street 1:685 MORRO AVE STE C
Practice Address - Street 2:
Practice Address - City:MORRO BAY
Practice Address - State:CA
Practice Address - Zip Code:93442-2233
Practice Address - Country:US
Practice Address - Phone:805-772-7313
Practice Address - Fax:805-346-3625
Is Sole Proprietor?:No
Enumeration Date:2010-07-27
Last Update Date:2024-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00298400363LF0000X
CA95029301363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily