Individual
MRS. JESSICA LORRAINE LUCAS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
R-MA
Contact information
Practice address
5049 W BEVERLY LN, GLENDALE, AZ 85306-2029
(602) 550-5839
(602) 550-5839
Mailing address
PO BOX 5085, PEORIA, AZ 85385-5085
(602) 550-5839
Taxonomy
Speciality
Code
Description
License number
State
253Z00000X
In Home Supportive Care Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2501137937
STATE OF ARIZONA DEPARTMENT OF PUBLIC SAFETY- FINGER PRINT CLEARANCE CARD
AZ
01
—
2791281
AMERICAN MEDICAL TECHNOLOGIES
AZ
01
—
54274
AMERICAN SAFETY & HEALTH INSTITUTE
AZ
Enumeration date
02/06/2018
Last updated
02/06/2018
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