Healthcare Provider Details

I. General information

NPI: 1720748700
Provider Name (Legal Business Name): LUCAS EISELER FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/18/2021
Last Update Date: 12/18/2021
Certification Date: 12/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 E MICHIGAN AVE
LANSING MI
48912-1810
US

IV. Provider business mailing address

3553 W MAPLE RAPIDS RD
SAINT JOHNS MI
48879-8510
US

V. Phone/Fax

Practice location:
  • Phone: 517-364-9790
  • Fax:
Mailing address:
  • Phone: 517-667-8817
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704306486
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: