Individual
KIMBERLY ANN LUCAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
5119 NE 57TH AVE, PORTLAND, OR 97218-2584
(503) 215-8050
Mailing address
4531 SE BELMONT ST, PORTLAND, OR 97215-1675
(503) 215-6556
Taxonomy
Speciality
Code
Description
License number
State
163WC1500X
Community Health Registered Nurse
Primary
201040038RN
OR
Other
Enumeration date
07/27/2019
Last updated
07/27/2019
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