Healthcare Provider Details

I. General information

NPI: 1518885367
Provider Name (Legal Business Name): CRYSTAL LUCAS RN, BSN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2026
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 W MALLON AVE
SPOKANE WA
99260-2043
US

IV. Provider business mailing address

16141 N RIGHT FORK RD
HAUSER ID
83854-6428
US

V. Phone/Fax

Practice location:
  • Phone: 509-477-6774
  • Fax:
Mailing address:
  • Phone: 360-560-0795
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number3171653
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: