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General NPI Number Information
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NPI Number | 1447927595
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Entity Type | Organization
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Legal Business Name | LUCAS EXCEPTIONAL HEALTHCARE AND CONSULTATION PLLC
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Dates
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Enumeration Date | 08/26/2021
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Last Update Date | 10/05/2023
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Provider Practice Location Address
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Address Line | 2211 W MEADOWVIEW RD STE 107
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City | GREENSBORO
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State | NC
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Zip | 27407-3408
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Country | US
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Telephone | 336-543-0480
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Fax | 336-313-2417
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Provider Business Mailing Address
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Address Line | 2211 W MEADOWVIEW RD STE 107
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City | GREENSBORO
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State | NC
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Zip | 27407-3408
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Country | US
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Telephone | 336-543-0480
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Fax | 336-313-2417
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Authorized Official
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Title or Position | CEO
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Name | LATOYA LUCAS
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Credential | APRN
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Telephone | 336-543-0480
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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