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NPI Code Detail

MEDICARE: KERRIE ANN-MARIE LUCAS NURSE PRACTITIONER

MEDICARE: KERRIE ANN-MARIE LUCAS NURSE PRACTITIONER
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
1363LF0000XFamily Nurse Practitioner4704222945MI

General Provider Information

NPI Number : 1205916285
Entity Type Code : Individual
Provider Name (Legal Business Name) : KERRIE ANN-MARIE LUCAS NURSE PRACTITIONER
Provider Business Mailing Address
First Line : 3901 BEAUBIEN ST # 2102
Second Line :
City : DETROIT
State : MI
Zip : 48201-2119
Country : US
Telephone Number : 313-745-5588
Fax Number : 313-993-8738
Provider Business Practice Location Address
First Line : 3901 BEAUBIEN ST # 2102
Second Line :
City : DETROIT
State : MI
Zip : 48201-2119
Country : US
Telephone Number : 313-745-5588
Fax Number : 313-993-8738
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/16/2006
Last Update Date : 01/09/2025

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Directions to “ KERRIE ANN-MARIE LUCAS NURSE PRACTITIONER” Practice Location

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