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General NPI Number Information
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NPI Number | 1497196539
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Entity Type | Individual
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Provider Name | LUCAS ALEXANDER KEMP CRNA
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Gender | Male
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Dates
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Enumeration Date | 07/16/2013
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Last Update Date | 07/16/2013
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Provider Practice Location Address
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Address Line | 3801 SPRING ST
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City | MOUNT PLEASANT
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State | WI
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Zip | 53405-1667
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Country | US
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Telephone | 126-268-7401
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Fax |
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Provider Business Mailing Address
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Address Line | 7111 FAIRWAY DR SUITE 450
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City | PALM BEACH GARDENS
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State | FL
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Zip | 33418-4204
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Country | US
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Telephone | 156-152-3202
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Fax |
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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 | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 176577-030
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | R 185793-5
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License Number State | MN
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