MEDICARE: GWENDOLYN ANN LUCAS ARNP

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	363LF0000X	Family Nurse Practitioner	363LF0000X	WA

General Provider Information

NPI Number	:	1821393083
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GWENDOLYN ANN LUCAS ARNP

Provider Business Mailing Address
First Line	:	522 W RIVERSIDE AVE STE N
Second Line	:
City	:	SPOKANE
State	:	WA
Zip	:	99201-0580
Country	:	US
Telephone Number	:	509-768-2249
Fax Number	:

Provider Business Practice Location Address
First Line	:	522 W RIVERSIDE AVE STE N
Second Line	:
City	:	SPOKANE
State	:	WA
Zip	:	99201-0580
Country	:	US
Telephone Number	:	509-768-2249
Fax Number	:

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

Provider Enumeration Date	:	01/20/2011
Last Update Date	:	08/12/2024

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