Provider Demographics
NPI:1497783237
Name:LUCAS, DENISE RYAN (CNP)
Entity Type:Individual
Prefix:MRS
First Name:DENISE
Middle Name:RYAN
Last Name:LUCAS
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:138 E MAIN ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:KENT
Mailing Address - State:OH
Mailing Address - Zip Code:44240-1407
Mailing Address - Country:US
Mailing Address - Phone:330-678-8011
Mailing Address - Fax:330-678-3877
Practice Address - Street 1:138 E MAIN ST
Practice Address - Street 2:SUITE 202
Practice Address - City:KENT
Practice Address - State:OH
Practice Address - Zip Code:44240-1407
Practice Address - Country:US
Practice Address - Phone:330-678-8011
Practice Address - Fax:330-678-3877
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2014-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHNP07979363LW0102X, 363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHNP18052OtherMEDICARE PTAN
OH2679098OtherMEDICAID LEGACY NUMBER
OHQ40912Medicare UPIN