MEDICARE: MARLIE E LUCAS FNP-BC

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	ARNP1107982	FL
2	363L00000X	Nurse Practitioner	AP3230	AZ

General Provider Information

NPI Number	:	1447370630
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARLIE E LUCAS FNP-BC

Provider Business Mailing Address
First Line	:	2002 N STOCKTON HILL RD
Second Line	:	STE 104
City	:	KINGMAN
State	:	AZ
Zip	:	86401-4698
Country	:	US
Telephone Number	:	804-554-9814
Fax Number	:	807-760-0254

Provider Business Practice Location Address
First Line	:	1810 MESQUITE AVE STE B
Second Line	:
City	:	LAKE HAVASU CITY
State	:	AZ
Zip	:	86403-5886
Country	:	US
Telephone Number	:	804-554-9814
Fax Number	:	480-776-0025

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

Provider Enumeration Date	:	03/30/2007
Last Update Date	:	02/07/2020

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