Provider Demographics
NPI:1841575677
Name:LUCAS, DAVID HENRY (LPN)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:HENRY
Last Name:LUCAS
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16535 TRANQUILITY CT SE APT 303
Mailing Address - Street 2:
Mailing Address - City:PRIOR LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55372-4459
Mailing Address - Country:US
Mailing Address - Phone:952-847-0821
Mailing Address - Fax:
Practice Address - Street 1:16535 TRANQUILITY CT SE APT 303
Practice Address - Street 2:
Practice Address - City:PRIOR LAKE
Practice Address - State:MN
Practice Address - Zip Code:55372-4459
Practice Address - Country:US
Practice Address - Phone:952-847-0821
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-12
Last Update Date:2011-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNL72333-2164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse