Healthcare Provider Details

I. General information

NPI: 1295779536
Provider Name (Legal Business Name): KRISTINE I LUCAS AUD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2006
Last Update Date: 11/14/2024
Certification Date: 11/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 VA CTR
AUGUSTA ME
04330-6719
US

IV. Provider business mailing address

5 BRIGHTTREE RD
NOBLEBORO ME
04555-9227
US

V. Phone/Fax

Practice location:
  • Phone: 207-623-8411
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number786
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: