Doctor Name: | PATRICIA MARION LUCAS |
NPI Number: | 1619955341 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | PA |
License Number: | 1046215 |
Business Practice Address: | 3458 Neely Rd 305 Mdg/mdos Mc Guire Afb, NJ - 086415312 |
Business Phone Number: | 6097549481 |
Business Fax Number: | 6097549661 |
Mailing Address: | 14 Carob Ct, LUMBERTON |
State: | NJ |
Postal Code: | 080484201 |
Phone Number: | 5802789114 |
Fax Number: | |
NPI Enumeration Date: | 01/03/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363AM0700X |
License Number: | 1046215 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | GA |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Physician Assistant |
Taxonomy Specialization: | Medical |
Taxonomy Definition: |