Provider Demographics
NPI:1760471924
Name:LUCAS, ANNETTE LOVELAND (CRNP)
Entity Type:Individual
Prefix:MRS
First Name:ANNETTE
Middle Name:LOVELAND
Last Name:LUCAS
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:MS
Other - First Name:ANNETTE
Other - Middle Name:
Other - Last Name:LOVELAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNP, RN
Mailing Address - Street 1:9795 PERRY HWY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:WEXFORD
Mailing Address - State:PA
Mailing Address - Zip Code:15090-9700
Mailing Address - Country:US
Mailing Address - Phone:412-366-7337
Mailing Address - Fax:412-366-5118
Practice Address - Street 1:9795 PERRY HWY
Practice Address - Street 2:SUITE 100
Practice Address - City:WEXFORD
Practice Address - State:PA
Practice Address - Zip Code:15090-9700
Practice Address - Country:US
Practice Address - Phone:412-366-7337
Practice Address - Fax:412-366-5118
Is Sole Proprietor?:No
Enumeration Date:2005-10-19
Last Update Date:2020-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN282613L163WP0200X
PAVP00177OD363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No163WP0200XNursing Service ProvidersRegistered NursePediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA02149OtherEPSDT PROVIDER NUMBER
PARN282613LOtherRN MEDICAL LIC NUMBER
PAVP001770DOtherCRNP LIC NUMBER
PARN282613LOtherRN MEDICAL LIC NUMBER