Basic Information
| Provider Information | |||||||||
| NPI: | 1013328145 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LURIA | ||||||||
| FirstName: | LYNETTE | ||||||||
| MiddleName: | LICCINI | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | RAF LAKENHEATH 48 MDG/SGHC | ||||||||
| Address2: | UNIT 5115 | ||||||||
| City: | APO | ||||||||
| State: | AE | ||||||||
| PostalCode: | 094615115 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 1638528124 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | RAF LAKENHEATH 48 MDG/SGHC | ||||||||
| Address2: | UNIT 5115 | ||||||||
| City: | APO | ||||||||
| State: | AE | ||||||||
| PostalCode: | 094615115 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 1638528124 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/12/2014 | ||||||||
| LastUpdateDate: | 06/10/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/06/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207ZC0500X | 125787 | FL | N | Allopathic & Osteopathic Physicians | Pathology | Cytopathology | 207ZP0102X | 125787 | FL | Y | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology & Clinical Pathology |
No ID Information.