Individual
MRS. ANNETTE LOVELAND LUCAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNP
Contact information
Practice address
9795 PERRY HWY, SUITE 100, WEXFORD, PA 15090-9700
(412) 366-7337
(412) 366-5118
Mailing address
9795 PERRY HWY, SUITE 100, WEXFORD, PA 15090-9700
(412) 366-7337
(412) 366-5118
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
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