Provider Demographics
NPI:1700189479
Name:ENSLIN, LUCUS WILLIAM (ARNP)
Entity Type:Individual
Prefix:MR
First Name:LUCUS
Middle Name:WILLIAM
Last Name:ENSLIN
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 50095
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98145-5095
Mailing Address - Country:US
Mailing Address - Phone:206-901-2000
Mailing Address - Fax:
Practice Address - Street 1:825 EASTLAKE AVE E
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98109-4405
Practice Address - Country:US
Practice Address - Phone:206-520-5700
Practice Address - Fax:206-632-2437
Is Sole Proprietor?:No
Enumeration Date:2010-12-17
Last Update Date:2022-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN61260852163W00000X
NMCNP01712363L00000X
NMCNP-01712363LF0000X
WAAP61260884363LP2300X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM84100079-EFF 12/1/14Medicaid
NMP01422156/DV3487OtherRAILROAD MEDICARE-ALBUQUERQUE
NM84100079Medicaid
NMP01422156/DV3487OtherRAILROAD MEDICARE-ALBUQUERQUE