Provider Demographics
NPI:1932177672
Name:LUCAS, CATHERINE MELVENA
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:MELVENA
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 1:32303 N 15TH LN
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85085-9006
Mailing Address - Country:US
Mailing Address - Phone:623-434-0583
Mailing Address - Fax:623-434-0583
Practice Address - Street 1:32303 N 15TH LN
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85085-9006
Practice Address - Country:US
Practice Address - Phone:623-434-0583
Practice Address - Fax:623-434-0583
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-09
Last Update Date:2015-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1894367500000X
AZCRNA0776367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCAN1225Medicaid
SCQ27572Medicare PIN
SCQ27572Medicare UPIN
SCAN1225Medicaid