MEDICARE: MRS. PATRICIA FALLON LUCAS NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	0001189462	VA

General Provider Information

NPI Number	:	1043548522
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. PATRICIA FALLON LUCAS NP

Provider Business Mailing Address
First Line	:	500 GROVE ST
Second Line	:
City	:	HERNDON
State	:	VA
Zip	:	20170-4735
Country	:	US
Telephone Number	:	703-620-4294
Fax Number	:

Provider Business Practice Location Address
First Line	:	500 GROVE ST
Second Line	:
City	:	HERNDON
State	:	VA
Zip	:	20170-4735
Country	:	US
Telephone Number	:	703-620-4294
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/23/2009
Last Update Date	:	11/23/2009

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