Provider Demographics
NPI:1124695606
Name:LUCAS, CATHY ANN (CNP)
Entity type:Individual
Prefix:
First Name:CATHY
Middle Name:ANN
Last Name:LUCAS
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18662 ROAD 20P
Mailing Address - Street 2:
Mailing Address - City:FORT JENNINGS
Mailing Address - State:OH
Mailing Address - Zip Code:45844-9112
Mailing Address - Country:US
Mailing Address - Phone:419-890-3267
Mailing Address - Fax:
Practice Address - Street 1:575 OTTAWA GLANDORF RD STE 3
Practice Address - Street 2:
Practice Address - City:OTTAWA
Practice Address - State:OH
Practice Address - Zip Code:45875-1932
Practice Address - Country:US
Practice Address - Phone:419-523-4449
Practice Address - Fax:419-523-6328
Is Sole Proprietor?:No
Enumeration Date:2021-06-04
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHF02210405363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily