Provider Demographics
NPI:1780849703
Name:LUCAS, TERRIE A (LPN)
Entity type:Individual
Prefix:
First Name:TERRIE
Middle Name:A
Last Name:LUCAS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:TERRIE
Other - Middle Name:A
Other - Last Name:SCOTT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPN
Mailing Address - Street 1:3981 EASTWAY RD
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44118-2311
Mailing Address - Country:US
Mailing Address - Phone:216-862-1199
Mailing Address - Fax:
Practice Address - Street 1:3981 EASTWAY RD
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44118-2311
Practice Address - Country:US
Practice Address - Phone:216-862-1199
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-21
Last Update Date:2008-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN091056164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse