MEDICARE: MRS. NICOLE SHIRRIE LUCAS L.P.N.

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	164W00000X	Licensed Practical Nurse	106187	OH

General Provider Information

NPI Number	:	1043513377
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. NICOLE SHIRRIE LUCAS L.P.N.

Provider Business Mailing Address
First Line	:	4635 E 131ST ST
Second Line	:	#211
City	:	GARFIELD HEIGHTS
State	:	OH
Zip	:	44105-7174
Country	:	US
Telephone Number	:	216-510-5514
Fax Number	:

Provider Business Practice Location Address
First Line	:	4635 E 131ST ST
Second Line	:	#211
City	:	GARFIELD HEIGHTS
State	:	OH
Zip	:	44105-7174
Country	:	US
Telephone Number	:	216-510-5514
Fax Number	:

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

Provider Enumeration Date	:	12/08/2010
Last Update Date	:	12/08/2010

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