Provider Demographics
NPI:1437612355
Name:MARLIE E LUCAS
Entity Type:Organization
Organization Name:MARLIE E LUCAS
Other - Org Name:LUCAS MEDICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FNP, OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:MARLIE
Authorized Official - Middle Name:ELAINE
Authorized Official - Last Name:LUCAS
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-BC
Authorized Official - Phone:928-715-9258
Mailing Address - Street 1:1751 N STOCKTON HILL RD STE B
Mailing Address - Street 2:
Mailing Address - City:KINGMAN
Mailing Address - State:AZ
Mailing Address - Zip Code:86401-6601
Mailing Address - Country:US
Mailing Address - Phone:928-715-9258
Mailing Address - Fax:
Practice Address - Street 1:1751 N STOCKTON HILL RD STE B
Practice Address - Street 2:
Practice Address - City:KINGMAN
Practice Address - State:AZ
Practice Address - Zip Code:86401-6601
Practice Address - Country:US
Practice Address - Phone:928-715-9258
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-08
Last Update Date:2019-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center