Provider Demographics
NPI:1518945906
Name:FAILS, LUCINDA A (CRNP, MSN)
Entity Type:Individual
Prefix:MS
First Name:LUCINDA
Middle Name:A
Last Name:FAILS
Suffix:
Gender:F
Credentials:CRNP, MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 COLONY BOULEVARD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:BLAIRSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15717-7971
Mailing Address - Country:US
Mailing Address - Phone:724-459-9111
Mailing Address - Fax:724-459-7856
Practice Address - Street 1:25 COLONY BOULEVARD
Practice Address - Street 2:SUITE 102
Practice Address - City:BLAIRSVILLE
Practice Address - State:PA
Practice Address - Zip Code:15717-7971
Practice Address - Country:US
Practice Address - Phone:724-459-9111
Practice Address - Fax:724-459-7856
Is Sole Proprietor?:No
Enumeration Date:2006-01-05
Last Update Date:2010-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAVP000981B363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA007387593Medicaid
PA007387593Medicaid
PA015809PP4Medicare PIN