Provider Demographics
NPI:1316181779
Name:LUCAS, MICHELE (RD)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:
Last Name:LUCAS
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 W POPLAR ST
Mailing Address - Street 2:PO BOX 1477
Mailing Address - City:WALLA WALLA
Mailing Address - State:WA
Mailing Address - Zip Code:99362-2828
Mailing Address - Country:US
Mailing Address - Phone:509-522-5906
Mailing Address - Fax:509-522-5789
Practice Address - Street 1:401 W POPLAR ST
Practice Address - Street 2:DIETARY DEPARTMENT
Practice Address - City:WALLA WALLA
Practice Address - State:WA
Practice Address - Zip Code:99362-2846
Practice Address - Country:US
Practice Address - Phone:509-525-3320
Practice Address - Fax:509-522-5912
Is Sole Proprietor?:No
Enumeration Date:2009-04-28
Last Update Date:2009-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA576629133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered