Provider Demographics
NPI:1487230983
Name:DONALDSON, LUCAS PAUL
Entity Type:Individual
Prefix:
First Name:LUCAS
Middle Name:PAUL
Last Name:DONALDSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8796 W TILLAMOOK DR
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83709-5876
Mailing Address - Country:US
Mailing Address - Phone:208-861-5609
Mailing Address - Fax:
Practice Address - Street 1:8796 W TILLAMOOK DR
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83709-5876
Practice Address - Country:US
Practice Address - Phone:208-861-5609
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-23
Last Update Date:2021-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID56025163WP1700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP1700XNursing Service ProvidersRegistered NursePerinatal