Provider Demographics
NPI:1316295215
Name:LUCIUS, CHERYL ANN (COTA)
Entity type:Individual
Prefix:MS
First Name:CHERYL
Middle Name:ANN
Last Name:LUCIUS
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2094 WILLOW CIR
Mailing Address - Street 2:2094 WILLOW CIRCLE
Mailing Address - City:CENTERVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55038-8774
Mailing Address - Country:US
Mailing Address - Phone:651-447-9250
Mailing Address - Fax:
Practice Address - Street 1:601 25TH AVE S
Practice Address - Street 2:601 25TH AVE SO.
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55454-1454
Practice Address - Country:US
Practice Address - Phone:651-690-7772
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-27
Last Update Date:2012-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2011432083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine