MEDICARE: MRS. NANCY LOUISE LUCAS RN, RNFA

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	163WR0006X	Registered Nurse First Assistant	RN056588	GA

General Provider Information

NPI Number	:	1124088950
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. NANCY LOUISE LUCAS RN, RNFA

Provider Business Mailing Address
First Line	:	2311 RIDGE FOREST DR
Second Line	:
City	:	GRAYSON
State	:	GA
Zip	:	30017-1718
Country	:	US
Telephone Number	:	678-656-6819
Fax Number	:

Provider Business Practice Location Address
First Line	:	2311 RIDGE FOREST DR
Second Line	:
City	:	GRAYSON
State	:	GA
Zip	:	30017-1718
Country	:	US
Telephone Number	:	678-656-6819
Fax Number	:

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

Provider Enumeration Date	:	03/24/2006
Last Update Date	:	08/09/2021

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