Basic Information
| Provider Information | |||||||||
| NPI: | 1447370630 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LUCAS | ||||||||
| FirstName: | MARLIE | ||||||||
| MiddleName: | E | ||||||||
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| Credential: | FNP-BC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2002 N STOCKTON HILL RD | ||||||||
| Address2: | STE 104 | ||||||||
| City: | KINGMAN | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 864014698 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8045549814 | ||||||||
| FaxNumber: | 8077600254 | ||||||||
| Practice Location | |||||||||
| Address1: | 1810 MESQUITE AVE STE B | ||||||||
| Address2: | |||||||||
| City: | LAKE HAVASU CITY | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 864035886 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8045549814 | ||||||||
| FaxNumber: | 4807760025 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/30/2007 | ||||||||
| LastUpdateDate: | 02/07/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/07/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | ARNP1107982 | FL | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 363L00000X | AP3230 | AZ | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.