Provider Demographics
NPI:1275776841
Name:LUCAS, JENNIFER M (ARNP)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:M
Last Name:LUCAS
Suffix:
Gender:F
Credentials:ARNP
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Mailing Address - Street 1:2710 SAINT FRANCIS DR
Mailing Address - Street 2:#320
Mailing Address - City:WATERLOO
Mailing Address - State:IA
Mailing Address - Zip Code:50702-5619
Mailing Address - Country:US
Mailing Address - Phone:319-272-5000
Mailing Address - Fax:319-272-8072
Practice Address - Street 1:2710 SAINT FRANCIS DR
Practice Address - Street 2:#320
Practice Address - City:WATERLOO
Practice Address - State:IA
Practice Address - Zip Code:50702-5619
Practice Address - Country:US
Practice Address - Phone:319-272-5000
Practice Address - Fax:319-272-8072
Is Sole Proprietor?:No
Enumeration Date:2009-04-13
Last Update Date:2016-07-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OK95031363L00000X
IAA143612363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200244510AMedicaid
OKOK402924Medicare UPIN