Provider Demographics
NPI:1275839615
Name:LUCAS, LISA M (APRN-BC, NP)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:M
Last Name:LUCAS
Suffix:
Gender:F
Credentials:APRN-BC, NP
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Other - First Name:
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Mailing Address - Street 1:4215 W PASADENA AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48504-2342
Mailing Address - Country:US
Mailing Address - Phone:616-301-1020
Mailing Address - Fax:866-595-6304
Practice Address - Street 1:4215 W PASADENA AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48504-2342
Practice Address - Country:US
Practice Address - Phone:616-301-1020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-02
Last Update Date:2015-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704237090363LA2200X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1134565336Medicaid