Provider Demographics
NPI:1194192310
Name:LUKENS, DANIEL
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:LUKENS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 LOCUST ST
Mailing Address - Street 2:APT. 23
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44302-1940
Mailing Address - Country:US
Mailing Address - Phone:330-208-4330
Mailing Address - Fax:
Practice Address - Street 1:125 LOCUST ST
Practice Address - Street 2:APT. 23
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44302-1940
Practice Address - Country:US
Practice Address - Phone:330-208-4330
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-24
Last Update Date:2015-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH401481400113374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0098927Medicaid