Provider Demographics
NPI:1184700379
Name:LUCAS, VALERIE RUTH (RNC WOMENS HEALTH NU)
Entity type:Individual
Prefix:MS
First Name:VALERIE
Middle Name:RUTH
Last Name:LUCAS
Suffix:
Gender:F
Credentials:RNC WOMENS HEALTH NU
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8514 BOLT DRIVE
Mailing Address - Street 2:
Mailing Address - City:ADA
Mailing Address - State:MI
Mailing Address - Zip Code:49301
Mailing Address - Country:US
Mailing Address - Phone:616-676-0345
Mailing Address - Fax:
Practice Address - Street 1:425 CHERRY SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49305
Practice Address - Country:US
Practice Address - Phone:616-774-7005
Practice Address - Fax:616-774-0516
Is Sole Proprietor?:No
Enumeration Date:2006-10-31
Last Update Date:2012-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704114827363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
N32840003Medicare UPIN