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Individual

JACKIE LAVETE LUCAS

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
19270 RED MAPLE CT, SOUTHFIELD, MI 48076-1006
(248) 296-1252
Mailing address
19270 RED MAPLE CT, SOUTHFIELD, MI 48076-1006
(248) 296-1252

Taxonomy

Speciality
Code
Description
License number
State
163WA2000X
Administrator Registered Nurse
Primary
4704261129
MI

Other

Enumeration date
07/26/2019
Last updated
07/26/2019
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