Provider Demographics
NPI:1972903490
Name:LUCAS, JENNIFER KRISTINE
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:KRISTINE
Last Name:LUCAS
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 1:14026 MANDOLIN WAY
Mailing Address - Street 2:
Mailing Address - City:NEVADA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95959-9422
Mailing Address - Country:US
Mailing Address - Phone:310-916-7154
Mailing Address - Fax:
Practice Address - Street 1:138 NEW MOHAWK RD
Practice Address - Street 2:STE 200
Practice Address - City:NEVADA CITY
Practice Address - State:CA
Practice Address - Zip Code:95959-3244
Practice Address - Country:US
Practice Address - Phone:530-478-0900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-03
Last Update Date:2014-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator