Provider Demographics
NPI:1760597124
Name:LUCAS, ROSA S (RN, NP)
Entity Type:Individual
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First Name:ROSA
Middle Name:S
Last Name:LUCAS
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Gender:F
Credentials:RN, NP
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Mailing Address - Street 1:72780 COUNTRY CLUB DR
Mailing Address - Street 2:BLDG B 203
Mailing Address - City:RANCHO MIRAGE
Mailing Address - State:CA
Mailing Address - Zip Code:92270-4126
Mailing Address - Country:US
Mailing Address - Phone:760-674-3847
Mailing Address - Fax:760-674-3845
Practice Address - Street 1:72780 COUNTY CLUB DRIVE
Practice Address - Street 2:BUILDING B 203
Practice Address - City:RANCHO MIRAGE
Practice Address - State:CA
Practice Address - Zip Code:92270-3221
Practice Address - Country:US
Practice Address - Phone:760-674-3847
Practice Address - Fax:760-674-3845
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2016-02-29
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Provider Licenses
StateLicense IDTaxonomies
CARN245660163WG0000X
CANP564363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice