Provider Demographics
NPI:1568077691
Name:LUCAS, CRYSTAL KAY
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:KAY
Last Name:LUCAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8262 DEPOT RD
Mailing Address - Street 2:
Mailing Address - City:LISBON
Mailing Address - State:OH
Mailing Address - Zip Code:44432-9424
Mailing Address - Country:US
Mailing Address - Phone:330-831-9118
Mailing Address - Fax:
Practice Address - Street 1:335 W PERSHING ST APT A
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OH
Practice Address - Zip Code:44460-2749
Practice Address - Country:US
Practice Address - Phone:330-831-9118
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-15
Last Update Date:2020-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide