Healthcare Provider Details

I. General information

NPI: 1609292127
Provider Name (Legal Business Name): RHONDA WELLS LUCAS NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2014
Last Update Date: 11/23/2022
Certification Date: 11/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2150 NC HIGHWAY 65
REIDSVILLE NC
27320-9609
US

IV. Provider business mailing address

2150 NC HIGHWAY 65
REIDSVILLE NC
27320-9609
US

V. Phone/Fax

Practice location:
  • Phone: 336-427-9022
  • Fax: 336-427-9030
Mailing address:
  • Phone: 336-427-9022
  • Fax: 336-427-9030

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number87154
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: