Healthcare Provider Details

I. General information

NPI: 1275776841
Provider Name (Legal Business Name): JENNIFER M LUCAS ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2009
Last Update Date: 07/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2710 SAINT FRANCIS DR #320
WATERLOO IA
50702-5619
US

IV. Provider business mailing address

2710 SAINT FRANCIS DR #320
WATERLOO IA
50702-5619
US

V. Phone/Fax

Practice location:
  • Phone: 319-272-5000
  • Fax: 319-272-8072
Mailing address:
  • Phone: 319-272-5000
  • Fax: 319-272-8072

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number95031
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberA143612
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: