Individual
LUCAS NATHAN VINE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA- C
Contact information
Practice address
276 KINGSBURY GRADE STE 101, STATELINE, NV 89449-9804
(775) 588-5000
Mailing address
276 KINGSBURY GRADE STE 101, STATELINE, NV 89449-9804
(775) 588-5000
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
PA3176
NV
Other
Enumeration date
03/21/2025
Last updated
03/21/2025
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