Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | AP138285 | TX |
N | 363LP0200X | Nurse Practitioner - Pediatrics | TEMP | TX |
NPI | 1023594009 |
---|---|
Provider Name | Erica M Lucas |
First Address | Irving, TX 75039-2014 |
Second Address | Fort Worth, TX 76104-2619 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/07/2018 |
Last Update Date | 25/01/2021 |