Provider Demographics
NPI:1811376072
Name:LUCIER, DEVAN COLE
Entity Type:Individual
Prefix:MS
First Name:DEVAN
Middle Name:COLE
Last Name:LUCIER
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 1:33 ROGER ST
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ME
Mailing Address - Zip Code:04240-3328
Mailing Address - Country:US
Mailing Address - Phone:207-784-0108
Mailing Address - Fax:
Practice Address - Street 1:33 ROGER ST
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ME
Practice Address - Zip Code:04240-3328
Practice Address - Country:US
Practice Address - Phone:207-784-0108
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-21
Last Update Date:2024-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT101.0109859207QA0505X
MECNP191079363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine