Provider Demographics
NPI:1952496135
Name:LUCAS, MELISSA A (CRNA)
Entity Type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:A
Last Name:LUCAS
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47 RIVER ST
Mailing Address - Street 2:
Mailing Address - City:FORTY FORT
Mailing Address - State:PA
Mailing Address - Zip Code:18704-5034
Mailing Address - Country:US
Mailing Address - Phone:202-997-9186
Mailing Address - Fax:
Practice Address - Street 1:500 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:WARRENTON
Practice Address - State:VA
Practice Address - Zip Code:20186-3027
Practice Address - Country:US
Practice Address - Phone:703-295-9360
Practice Address - Fax:703-295-9369
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024166199367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010200211Medicaid
VAK142-0002OtherCARE FIRST 2005
VA010196744Medicaid
VA484645OtherNCPPO
VAP00247369OtherRAILROAD MEDICARE
VA010196442Medicaid
VA139230OtherTRIGON
VA010196744Medicaid
VA010196442Medicaid