Doctor Name: | LUCAS ALLEN FUSSELL |
NPI Number: | 1619226438 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | NP |
License Number: | 0024170248 |
Business Practice Address: | 20306 Badger Lane Onley, VA - 234180159 |
Business Phone Number: | 7577877374 |
Business Fax Number: | 7577874581 |
Mailing Address: | 20306 Badger Lane, ONLEY |
State: | VA |
Postal Code: | 234180159 |
Phone Number: | 7577877374 |
Fax Number: | 7577874581 |
NPI Enumeration Date: | 09/07/2012 |
NPI Last Update Date: | 04/14/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | 0024170248 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | VA |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |