Healthcare Provider Details

I. General information

NPI: 1760471924
Provider Name (Legal Business Name): ANNETTE LOVELAND LUCAS CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANNETTE LOVELAND CRNP, RN

II. Dates (important events)

Enumeration Date: 10/19/2005
Last Update Date: 10/02/2020
Certification Date: 10/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9795 PERRY HWY SUITE 100
WEXFORD PA
15090-9700
US

IV. Provider business mailing address

9795 PERRY HWY SUITE 100
WEXFORD PA
15090-9700
US

V. Phone/Fax

Practice location:
  • Phone: 412-366-7337
  • Fax: 412-366-5118
Mailing address:
  • Phone: 412-366-7337
  • Fax: 412-366-5118

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License NumberRN282613L
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberVP00177OD
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: