Individual
SHELLALYN ITO-LUCAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3643 N ROXBORO ST, DURHAM, NC 27704-2702
(919) 470-4000
Mailing address
1000 LAKESIDE TERRACE CT APT 112, WAKE FOREST, NC 27587-3221
(973) 452-1892
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
26NR11878000
NJ
363LA2100X
Acute Care Nurse Practitioner
Primary
5018236
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1295214013
NPI
—
Enumeration date
08/13/2018
Last updated
08/04/2023
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