Provider Demographics
NPI:1003002957
Name:LUCAS, SUZANNE (LAC)
Entity Type:Individual
Prefix:MS
First Name:SUZANNE
Middle Name:
Last Name:LUCAS
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12821 N CAVE CREEK RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85022-5862
Mailing Address - Country:US
Mailing Address - Phone:602-404-8483
Mailing Address - Fax:602-493-2246
Practice Address - Street 1:12821 N CAVE CREEK RD
Practice Address - Street 2:SUITE 101
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85022-5862
Practice Address - Country:US
Practice Address - Phone:602-404-8483
Practice Address - Fax:602-493-2246
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-24
Last Update Date:2007-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0192171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist