Provider Demographics
NPI:1023361599
Name:HANISCH-LUCAS, BARBARA L (MSN, FNP)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:L
Last Name:HANISCH-LUCAS
Suffix:
Gender:F
Credentials:MSN, FNP
Other - Prefix:
Other - First Name:BARBARA
Other - Middle Name:L
Other - Last Name:HANISCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1260 S CAMPBELL AVE
Mailing Address - Street 2:BUILDING 2
Mailing Address - City:GREEN VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85614-0503
Mailing Address - Country:US
Mailing Address - Phone:520-407-5600
Mailing Address - Fax:520-407-5990
Practice Address - Street 1:13299 E COLOSSAL CAVE RD
Practice Address - Street 2:
Practice Address - City:VAIL
Practice Address - State:AZ
Practice Address - Zip Code:85641-9001
Practice Address - Country:US
Practice Address - Phone:520-762-5200
Practice Address - Fax:520-407-5990
Is Sole Proprietor?:No
Enumeration Date:2012-10-22
Last Update Date:2013-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN087930363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily