Individual
TY LUCAS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
42 LUCAS LN, MARTINSBURG, WV 25403-5408
(304) 901-6135
Mailing address
42 LUCAS LN, MARTINSBURG, WV 25403-5408
(304) 901-6135
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
Primary
—
—
Other
Enumeration date
07/15/2021
Last updated
07/15/2021
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