Provider Demographics
NPI:1912739251
Name:LUCAS, RACHEL MICHELLE
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:MICHELLE
Last Name:LUCAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5407 15TH AVE NE APT B108
Mailing Address - Street 2:
Mailing Address - City:LACEY
Mailing Address - State:WA
Mailing Address - Zip Code:98516-5761
Mailing Address - Country:US
Mailing Address - Phone:916-956-9619
Mailing Address - Fax:
Practice Address - Street 1:4228 BAINBRIDGE CT NE
Practice Address - Street 2:
Practice Address - City:LACEY
Practice Address - State:WA
Practice Address - Zip Code:98516-6219
Practice Address - Country:US
Practice Address - Phone:360-742-3920
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-15
Last Update Date:2024-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider