Individual
JANE LUCAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
651 S CLARIZZ BLVD, BLOOMINGTON, IN 47401-5523
(812) 333-2304
(812) 330-2306
Mailing address
651 S CLARIZZ BLVD, BLOOMINGTON, IN 47401-5523
(812) 333-2304
(812) 330-2306
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
71000361A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201097360
—
IN
Enumeration date
09/23/2005
Last updated
02/21/2013
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