Provider Demographics
NPI:1588202261
Name:LUCAS, KATHLEEN MS
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:MS
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 1:32335 OLD LINCOLN HWY
Mailing Address - Street 2:
Mailing Address - City:MISSOURI VALLEY
Mailing Address - State:IA
Mailing Address - Zip Code:51555-6027
Mailing Address - Country:US
Mailing Address - Phone:402-960-3590
Mailing Address - Fax:
Practice Address - Street 1:32335 OLD LINCOLN HWY
Practice Address - Street 2:
Practice Address - City:MISSOURI VALLEY
Practice Address - State:IA
Practice Address - Zip Code:51555-6027
Practice Address - Country:US
Practice Address - Phone:402-960-3590
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-13
Last Update Date:2019-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care ProviderGroup - Single Specialty