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General NPI Number Information
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NPI Number | 1679816813
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Entity Type | Individual
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Provider Name | RACHEL CREA LUCAS D.O.
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Gender | Female
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Dates
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Enumeration Date | 04/05/2013
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Last Update Date | 04/13/2023
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Provider Practice Location Address
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Address Line | 4855 N. MOORLAND ROAD URGENT CARE CLINIC
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City | NEW BERLIN
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State | WI
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Zip | 53151-7494
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Country | US
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Telephone | 262-432-7599
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Fax | 262-432-7694
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Provider Business Mailing Address
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Address Line | 300 CASSIDY AVE
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City | LEXINGTON
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State | KY
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Zip | 40502-2503
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Country | US
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Telephone | 952-412-5669
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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 | 2080H0002X
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Taxonomy Name | Pediatric Hospice and Palliative Medicine Physician
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License Number | 05259
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 63288-21
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License Number State | WI
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