Provider Demographics
NPI:1700020401
Name:LUCAS, SHAWN LAMAR (LPN)
Entity Type:Individual
Prefix:
First Name:SHAWN
Middle Name:LAMAR
Last Name:LUCAS
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 1:3789 WALNUT CREEK DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43224-2527
Mailing Address - Country:US
Mailing Address - Phone:614-735-3194
Mailing Address - Fax:
Practice Address - Street 1:3789 WALNUT CREEK DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43224-2527
Practice Address - Country:US
Practice Address - Phone:614-735-3194
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-24
Last Update Date:2009-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN123121-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse