Provider Demographics
NPI:1891029443
Name:LUCAS, LIZZEL LORRAINE (RN)
Entity Type:Individual
Prefix:
First Name:LIZZEL
Middle Name:LORRAINE
Last Name:LUCAS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2831 N 45TH ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53210-1714
Mailing Address - Country:US
Mailing Address - Phone:414-813-2943
Mailing Address - Fax:
Practice Address - Street 1:2831 N 45TH ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53210-1714
Practice Address - Country:US
Practice Address - Phone:414-813-2943
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-30
Last Update Date:2009-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI116739-30163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse