Provider Demographics
NPI:1366542193
Name:LUCAS, WILLIAM CLYDE (FNP)
Entity type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:CLYDE
Last Name:LUCAS
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1681
Mailing Address - Street 2:
Mailing Address - City:GREEN VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85622-1681
Mailing Address - Country:US
Mailing Address - Phone:520-625-5853
Mailing Address - Fax:
Practice Address - Street 1:7640 W. MAVERICK RD.
Practice Address - Street 2:
Practice Address - City:SAHUARITA
Practice Address - State:AZ
Practice Address - Zip Code:85629
Practice Address - Country:US
Practice Address - Phone:520-625-5853
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN 039777363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
29580Medicare ID - Type Unspecified
Z79159Medicare ID - Type Unspecified
S70450Medicare UPIN