Provider Demographics
NPI:1669861712
Name:BILA, LUCAS JAMES EVAN JOSEPH (LPN)
Entity Type:Individual
Prefix:
First Name:LUCAS
Middle Name:JAMES EVAN JOSEPH
Last Name:BILA
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2204 S WADSWORTH DR
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48911-2450
Mailing Address - Country:US
Mailing Address - Phone:517-819-2502
Mailing Address - Fax:
Practice Address - Street 1:2204 S. WADSWORTH DR
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48911
Practice Address - Country:US
Practice Address - Phone:517-819-2502
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-13
Last Update Date:2015-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4703114586164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse