MEDICARE: COLLEEN LUCAS RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	821777	TX
2	363L00000X	Nurse Practitioner	AP138801	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	AP138801	OTHER	TX	APRN LICENSE

General Provider Information

NPI Number	:	1013406065
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	COLLEEN LUCAS RN

Provider Business Mailing Address
First Line	:	701 N VISTA RIDGE BLVD APT 12310
Second Line	:
City	:	CEDAR PARK
State	:	TX
Zip	:	78613-0024
Country	:	US
Telephone Number	:	512-905-0229
Fax Number	:

Provider Business Practice Location Address
First Line	:	101 W KOENIG LN STE 100
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78751-1213
Country	:	US
Telephone Number	:	512-454-9426
Fax Number	:	512-454-7294

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/05/2018
Last Update Date	:	09/30/2019

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