Provider Demographics
NPI:1710538764
Name:LUCAS, JILL K
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:K
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:PO BOX 264
Mailing Address - Street 2:
Mailing Address - City:SPENCER
Mailing Address - State:OH
Mailing Address - Zip Code:44275-0264
Mailing Address - Country:US
Mailing Address - Phone:330-648-7003
Mailing Address - Fax:
Practice Address - Street 1:6800 SPENCER RD
Practice Address - Street 2:
Practice Address - City:SPENCER
Practice Address - State:OH
Practice Address - Zip Code:44275-9779
Practice Address - Country:US
Practice Address - Phone:330-648-7003
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-21
Last Update Date:2019-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider