Healthcare Provider Details

I. General information

NPI: 1023361599
Provider Name (Legal Business Name): BARBARA L HANISCH-LUCAS MSN, FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BARBARA L HANISCH

II. Dates (important events)

Enumeration Date: 10/22/2012
Last Update Date: 04/20/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13299 E COLOSSAL CAVE RD
VAIL AZ
85641-9001
US

IV. Provider business mailing address

1260 S CAMPBELL AVE BUILDING 2
GREEN VALLEY AZ
85614-0503
US

V. Phone/Fax

Practice location:
  • Phone: 520-762-5200
  • Fax: 520-407-5990
Mailing address:
  • Phone: 520-407-5600
  • Fax: 520-407-5990

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN087930
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: