Healthcare Provider Details

I. General information

NPI: 1811487614
Provider Name (Legal Business Name): ERIN ELIZABETH LUCAS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2018
Last Update Date: 04/10/2020
Certification Date: 04/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2647 UNION DR
AMES IA
50011-2034
US

IV. Provider business mailing address

2647 UNION DR
AMES IA
50011-2034
US

V. Phone/Fax

Practice location:
  • Phone: 515-294-5801
  • Fax: 515-294-1190
Mailing address:
  • Phone: 515-294-5801
  • Fax: 515-294-1190

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number091181
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: