Provider Demographics
NPI:1568442028
Name:LUCAS, MARY C (CRNA)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:C
Last Name:LUCAS
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 N CENTER ST
Mailing Address - Street 2:STE 201
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28601-5036
Mailing Address - Country:US
Mailing Address - Phone:828-327-8105
Mailing Address - Fax:828-327-4245
Practice Address - Street 1:415 N CENTER ST
Practice Address - Street 2:STE 201
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28601-5036
Practice Address - Country:US
Practice Address - Phone:828-327-8105
Practice Address - Fax:828-327-4245
Is Sole Proprietor?:No
Enumeration Date:2006-01-20
Last Update Date:2008-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC115324367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC805027Medicaid
NC805027Medicaid
NC2613251BMedicare ID - Type Unspecified