Provider Demographics
NPI:1528524337
Name:LUCAS, NICOLE ANNA (MS-FNP)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:ANNA
Last Name:LUCAS
Suffix:
Gender:F
Credentials:MS-FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:687 CHESHIRE AVE
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97402-5060
Mailing Address - Country:US
Mailing Address - Phone:541-762-4325
Mailing Address - Fax:541-762-0740
Practice Address - Street 1:687 CHESHIRE AVE
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97402-5060
Practice Address - Country:US
Practice Address - Phone:541-762-4325
Practice Address - Fax:541-762-0740
Is Sole Proprietor?:No
Enumeration Date:2019-02-17
Last Update Date:2024-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP61267458363LF0000X
MI4704293466363LF0000X
OR201907459NP-PP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily