| NPI | 1710959317 |
|---|---|
| Former Name | KELLY L LUKOVSKI |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: OH 50-002191) |
| 363AM0700X Physician Assistant, Medical | |
| 363AM0700X Physician Assistant, Medical | |
| 2255A2300X Specialist/Technologist, Athletic Trainer | |
| Enumeration Date | 2006-02-07 |
| Last Update Date | 2021-05-29 |