Provider Demographics
NPI:1699111633
Name:SUTHERS, LUCAS ADAM (APNP)
Entity type:Individual
Prefix:MR
First Name:LUCAS
Middle Name:ADAM
Last Name:SUTHERS
Suffix:
Gender:M
Credentials:APNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 CLAY ST
Mailing Address - Street 2:
Mailing Address - City:DARLINGTON
Mailing Address - State:WI
Mailing Address - Zip Code:53530-1228
Mailing Address - Country:US
Mailing Address - Phone:608-776-4466
Mailing Address - Fax:608-776-5711
Practice Address - Street 1:731 CLAY ST
Practice Address - Street 2:
Practice Address - City:DARLINGTON
Practice Address - State:WI
Practice Address - Zip Code:53530-1225
Practice Address - Country:US
Practice Address - Phone:608-776-4497
Practice Address - Fax:608-776-2837
Is Sole Proprietor?:No
Enumeration Date:2013-05-16
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI195715-30163WG0000X
WI8070-33363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice