Provider Demographics
NPI:1154178671
Name:LUCAS, NICK
Entity type:Individual
Prefix:
First Name:NICK
Middle Name:
Last Name:LUCAS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3300 S NEEDLES HWY APT 21
Mailing Address - Street 2:
Mailing Address - City:LAUGHLIN
Mailing Address - State:NV
Mailing Address - Zip Code:89029-0159
Mailing Address - Country:US
Mailing Address - Phone:559-339-8752
Mailing Address - Fax:
Practice Address - Street 1:3300 S NEEDLES HWY APT 21
Practice Address - Street 2:
Practice Address - City:LAUGHLIN
Practice Address - State:NV
Practice Address - Zip Code:89029-0159
Practice Address - Country:US
Practice Address - Phone:559-339-8752
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-02
Last Update Date:2024-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant