Provider Demographics
NPI:1538824537
Name:LUCAS, MARY
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:LUCAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11019 BECONTREE LAKE DR APT 306
Mailing Address - Street 2:
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20190-4134
Mailing Address - Country:US
Mailing Address - Phone:269-384-9747
Mailing Address - Fax:
Practice Address - Street 1:11019 BECONTREE LAKE DR APT 306
Practice Address - Street 2:
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20190-4134
Practice Address - Country:US
Practice Address - Phone:269-384-9747
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-03
Last Update Date:2021-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula