Provider Demographics
NPI:1417967209
Name:LUCEY, JASON (NP)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:LUCEY
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:540 LAFAYETTE RD
Mailing Address - Street 2:SUITE 8
Mailing Address - City:HAMPTON
Mailing Address - State:NH
Mailing Address - Zip Code:03842-3344
Mailing Address - Country:US
Mailing Address - Phone:603-926-0088
Mailing Address - Fax:603-926-2853
Practice Address - Street 1:789 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:NH
Practice Address - Zip Code:03820-2526
Practice Address - Country:US
Practice Address - Phone:603-740-2163
Practice Address - Fax:603-740-2246
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2008-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH053322-23-03363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NHP00371472OtherRAILROAD THRU SEACOAST ER
NH30343093Medicaid
NH40Y007328NH01OtherBCBS THRU SEACOAST ER
NHP49907Medicare UPIN
NHUX8818Medicare PIN
NHP00371472OtherRAILROAD THRU SEACOAST ER