Individual
JENNIFER RAUN LUCAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
3015 E MAGIC VIEW DR, MERIDIAN, ID 83642-3757
(208) 321-4000
Mailing address
3015 E MAGIC VIEW DR, MERIDIAN, ID 83642-3757
(208) 321-4000
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
1422
ID
Other
Enumeration date
11/04/2016
Last updated
11/04/2016
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