Provider Demographics
NPI:1538990213
Name:COLQUHOUN, LUCAN
Entity type:Individual
Prefix:
First Name:LUCAN
Middle Name:
Last Name:COLQUHOUN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 ALIJO DR
Mailing Address - Street 2:
Mailing Address - City:WEST YARMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02673-2563
Mailing Address - Country:US
Mailing Address - Phone:508-360-5095
Mailing Address - Fax:
Practice Address - Street 1:12 ALIJO DR
Practice Address - Street 2:
Practice Address - City:WEST YARMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02673-2563
Practice Address - Country:US
Practice Address - Phone:508-360-5095
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-13
Last Update Date:2024-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2290855163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse