Healthcare Provider Details

I. General information

NPI: 1023752631
Provider Name (Legal Business Name): NATASHA LUCAS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: NATASHA SKALA

II. Dates (important events)

Enumeration Date: 04/21/2022
Last Update Date: 04/21/2022
Certification Date: 04/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 4TH AVE W
TURTLE LAKE ND
58575-4018
US

IV. Provider business mailing address

301 4TH AVE W
TURTLE LAKE ND
58575-4018
US

V. Phone/Fax

Practice location:
  • Phone: 218-280-4367
  • Fax:
Mailing address:
  • Phone: 218-280-4367
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: