Healthcare Provider Details

I. General information

NPI: 1518314541
Provider Name (Legal Business Name): JESSICA LUCIER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/19/2016
Last Update Date: 11/01/2024
Certification Date: 10/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

VANCOUVER CLINIC 87TH AVE
VANCOUVER WA
98664
US

IV. Provider business mailing address

VANCOUVER CLINIC 87TH AVE
VANCOUVER WA
98664
US

V. Phone/Fax

Practice location:
  • Phone: 360-882-2778
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberMD61129493
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: