Provider Demographics
NPI:1316251853
Name:LUKAN, SUSAN SPARKS (NP)
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:SPARKS
Last Name:LUKAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MS
Other - First Name:SUSAN
Other - Middle Name:SPARKS
Other - Last Name:CASSIDY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:ROOM 003001 ORANGE ZONE, DUKE SOUTH SB
Mailing Address - Street 2:DUKE UNIVERSITY HOSPITAL, DEPT. ADVANCED CLIN. PRACTICE
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27710
Mailing Address - Country:US
Mailing Address - Phone:510-427-8464
Mailing Address - Fax:
Practice Address - Street 1:1303 WELLSTONE CIRCLE
Practice Address - Street 2:
Practice Address - City:APEX
Practice Address - State:NC
Practice Address - Zip Code:27502
Practice Address - Country:US
Practice Address - Phone:510-427-8464
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-27
Last Update Date:2015-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5007770363LA2100X
CA19957363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care