Provider Demographics
NPI:1194259010
Name:CARL, LUCINTA
Entity type:Individual
Prefix:
First Name:LUCINTA
Middle Name:
Last Name:CARL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5508 AIRPORT WAY
Mailing Address - Street 2:
Mailing Address - City:NEWTOK
Mailing Address - State:AK
Mailing Address - Zip Code:99559
Mailing Address - Country:US
Mailing Address - Phone:907-237-2111
Mailing Address - Fax:907-237-2715
Practice Address - Street 1:5508 AIRPORT WAY
Practice Address - Street 2:
Practice Address - City:NEWTOK
Practice Address - State:AK
Practice Address - Zip Code:99559
Practice Address - Country:US
Practice Address - Phone:907-237-2111
Practice Address - Fax:907-237-2715
Is Sole Proprietor?:No
Enumeration Date:2017-04-18
Last Update Date:2017-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker