Provider Demographics
NPI:1073130209
Name:LUCAS, ASHLEY LAURA (RN, IBCLC)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:LAURA
Last Name:LUCAS
Suffix:
Gender:F
Credentials:RN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5879 CROOKED CREEK DR
Mailing Address - Street 2:
Mailing Address - City:OOLTEWAH
Mailing Address - State:TN
Mailing Address - Zip Code:37363-6571
Mailing Address - Country:US
Mailing Address - Phone:423-619-3622
Mailing Address - Fax:
Practice Address - Street 1:5879 CROOKED CREEK DR
Practice Address - Street 2:
Practice Address - City:OOLTEWAH
Practice Address - State:TN
Practice Address - Zip Code:37363-6571
Practice Address - Country:US
Practice Address - Phone:423-619-3622
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-03
Last Update Date:2020-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRN0000163787163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation ConsultantGroup - Single Specialty