Provider Demographics
NPI:1437658317
Name:LUCAS, JESSICA LORRAINE (R-MA)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:LORRAINE
Last Name:LUCAS
Suffix:
Gender:F
Credentials:R-MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5085
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85385-5085
Mailing Address - Country:US
Mailing Address - Phone:602-550-5839
Mailing Address - Fax:
Practice Address - Street 1:5049 W BEVERLY LN
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85306-2029
Practice Address - Country:US
Practice Address - Phone:602-550-5839
Practice Address - Fax:602-550-5839
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-06
Last Update Date:2018-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ2501137937OtherSTATE OF ARIZONA DEPARTMENT OF PUBLIC SAFETY- FINGER PRINT CLEARANCE CARD
AZ54274OtherAMERICAN SAFETY & HEALTH INSTITUTE
AZ2791281OtherAMERICAN MEDICAL TECHNOLOGIES