MEDICARE: MS. NICOLE RENEE LUCAS CLC,CLES

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	174N00000X	Lactation Consultant (Non-RN)

General Provider Information

NPI Number	:	1902748692
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. NICOLE RENEE LUCAS CLC,CLES

Provider Business Mailing Address
First Line	:	4900 E CHAPMAN AVE UNIT 79
Second Line	:
City	:	ORANGE
State	:	CA
Zip	:	92869-4142
Country	:	US
Telephone Number	:	714-743-3669
Fax Number	:

Provider Business Practice Location Address
First Line	:	4900 E CHAPMAN AVE UNIT 79
Second Line	:
City	:	ORANGE
State	:	CA
Zip	:	92869-4142
Country	:	US
Telephone Number	:	714-743-3669
Fax Number	:

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

Provider Enumeration Date	:	04/09/2026
Last Update Date	:	04/09/2026

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