Individual
MRS. ANNETTE LOVELAND LUCAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNP
Taxonomy
Speciality
Code
Description
License number
State
163WP0200X
Pediatric Registered Nurse
RN282613L
PA
363LP0200X
Pediatric Nurse Practitioner
Primary
VP00177OD
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
02149
EPSDT PROVIDER NUMBER
PA
01
—
RN282613L
RN MEDICAL LIC NUMBER
PA
01
—
VP001770D
CRNP LIC NUMBER
PA
Enumeration date
10/19/2005
Last updated
10/02/2020
Update your record
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