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General NPI Number Information
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NPI Number | 1447370630
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Entity Type | Individual
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Provider Name | MARLIE E LUCAS FNP-BC
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Gender | Female
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Dates
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Enumeration Date | 03/30/2007
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Last Update Date | 02/07/2020
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Provider Practice Location Address
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Address Line | 1810 MESQUITE AVE STE B
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City | LAKE HAVASU CITY
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State | AZ
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Zip | 86403-5886
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Country | US
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Telephone | 804-554-9814
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Fax | 480-776-0025
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Provider Business Mailing Address
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Address Line | 2002 N STOCKTON HILL RD STE 104
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City | KINGMAN
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State | AZ
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Zip | 86401-4698
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Country | US
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Telephone | 804-554-9814
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Fax | 807-760-0254
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | ARNP1107982
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | AP3230
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License Number State | AZ
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