Provider Demographics
NPI:1649266628
Name:LUCAS, JANE (NP)
Entity type:Individual
Prefix:
First Name:JANE
Middle Name:
Last Name:LUCAS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:JANE
Other - Middle Name:
Other - Last Name:LAUGHLIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:651 S CLARIZZ BLVD
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47401-5523
Mailing Address - Country:US
Mailing Address - Phone:812-333-2304
Mailing Address - Fax:812-330-2306
Practice Address - Street 1:651 S CLARIZZ BLVD
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47401-5523
Practice Address - Country:US
Practice Address - Phone:812-333-2304
Practice Address - Fax:812-330-2306
Is Sole Proprietor?:No
Enumeration Date:2005-09-23
Last Update Date:2013-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71000361A363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201097360Medicaid