Provider Demographics
NPI:1801200167
Name:LUCAS, JACLYN ELIZABETH (MPAS, PA-C)
Entity Type:Individual
Prefix:
First Name:JACLYN
Middle Name:ELIZABETH
Last Name:LUCAS
Suffix:
Gender:F
Credentials:MPAS, PA-C
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Mailing Address - Street 1:N27W22477 BURNINGWOOD LN
Mailing Address - Street 2:
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53186-8811
Mailing Address - Country:US
Mailing Address - Phone:262-442-4522
Mailing Address - Fax:
Practice Address - Street 1:150 S SUNNY SLOPE RD STE 136
Practice Address - Street 2:
Practice Address - City:BROOKFIELD
Practice Address - State:WI
Practice Address - Zip Code:53005-4858
Practice Address - Country:US
Practice Address - Phone:262-786-4550
Practice Address - Fax:262-786-4552
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-15
Last Update Date:2022-07-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WI3343.023363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical