Provider Demographics
NPI:1841902053
Name:MEREDITH, LUCAS MATTHIAS (RN)
Entity type:Individual
Prefix:
First Name:LUCAS
Middle Name:MATTHIAS
Last Name:MEREDITH
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:780 SWIFT BLVD STE 301
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99352-3524
Mailing Address - Country:US
Mailing Address - Phone:509-942-3178
Mailing Address - Fax:509-946-1735
Practice Address - Street 1:108 COLUMBIA POINT DR
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99352-4387
Practice Address - Country:US
Practice Address - Phone:509-946-0189
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-19
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN60223623163W00000X
WAAP61411933363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse