Provider Demographics
NPI:1205113339
Name:LUCAS, BRIDGET M (C-PNP)
Entity type:Individual
Prefix:
First Name:BRIDGET
Middle Name:M
Last Name:LUCAS
Suffix:
Gender:F
Credentials:C-PNP
Other - Prefix:
Other - First Name:BRIDGET
Other - Middle Name:M
Other - Last Name:GERNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:C-PNP
Mailing Address - Street 1:7974 UW HEALTH CT
Mailing Address - Street 2:
Mailing Address - City:MIDDLETON
Mailing Address - State:WI
Mailing Address - Zip Code:53562-5531
Mailing Address - Country:US
Mailing Address - Phone:608-829-5485
Mailing Address - Fax:
Practice Address - Street 1:13123 E 16TH AVE
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80045-7106
Practice Address - Country:US
Practice Address - Phone:720-777-1234
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-03
Last Update Date:2021-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.0990186-NP363LA2100X
CO990186363LP0200X
WI10409363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO40005861Medicaid
CO40005861Medicare PIN