Provider Demographics
NPI:1285658369
Name:LUCAS, ANN (CRNP)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:
Last Name:LUCAS
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:229 N POTOMAC ST
Mailing Address - Street 2:
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21740-3812
Mailing Address - Country:US
Mailing Address - Phone:301-733-5858
Mailing Address - Fax:866-635-7206
Practice Address - Street 1:229 N POTOMAC ST
Practice Address - Street 2:
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21740-3812
Practice Address - Country:US
Practice Address - Phone:301-733-5858
Practice Address - Fax:866-635-7206
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2012-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR114858363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD405909300Medicaid
MDPVPB10075730OtherAPS PROVIDER ID
MD544865-03OtherBC/BS
MDK025W538Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER