Provider Demographics
NPI:1306894837
Name:LUCARELLI, KRISTINA MUTHER (MSN)
Entity type:Individual
Prefix:
First Name:KRISTINA
Middle Name:MUTHER
Last Name:LUCARELLI
Suffix:
Gender:F
Credentials:MSN
Other - Prefix:
Other - First Name:KRISTINA
Other - Middle Name:DORIS
Other - Last Name:MUTHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2710 WATERS EDGE TRL
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30075-8216
Mailing Address - Country:US
Mailing Address - Phone:404-520-0162
Mailing Address - Fax:
Practice Address - Street 1:341 PONCE DE LEON AVENUE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30308
Practice Address - Country:US
Practice Address - Phone:404-520-0162
Practice Address - Fax:404-616-9732
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-05
Last Update Date:2010-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN153996363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily