Provider Demographics
NPI:1144689878
Name:LUCAS, ANWAR (LPN)
Entity type:Individual
Prefix:MR
First Name:ANWAR
Middle Name:
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 1:2669 WENDEE DR APT 1804
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45238-2704
Mailing Address - Country:US
Mailing Address - Phone:513-512-3232
Mailing Address - Fax:
Practice Address - Street 1:4721 REAING ROAD
Practice Address - Street 2:ST. ALOYSIUS ORPHANAGE
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45237
Practice Address - Country:US
Practice Address - Phone:513-242-7600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-23
Last Update Date:2016-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN.145048-M-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse