Provider Demographics
NPI:1912236340
Name:LUMLEY, LUCIA JANE (PA-C)
Entity Type:Individual
Prefix:
First Name:LUCIA
Middle Name:JANE
Last Name:LUMLEY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5757 W. THUNDERBIRD RD
Mailing Address - Street 2:E255
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85306-4699
Mailing Address - Country:US
Mailing Address - Phone:602-843-1991
Mailing Address - Fax:602-843-3224
Practice Address - Street 1:5757 W THUNDERBIRD RD
Practice Address - Street 2:E255
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85306-4641
Practice Address - Country:US
Practice Address - Phone:602-843-1991
Practice Address - Fax:602-843-3224
Is Sole Proprietor?:No
Enumeration Date:2009-12-14
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4500363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ4500OtherARIZONA LICENSE
AZ4500OtherARIZONA LICENSE