Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2100X | Nurse Practitioner - Acute Care | SP010308 | PA |
NPI | 1043446065 |
---|---|
Provider Name | Karen Lucas |
First Address | Philadelphia, PA 19104-2640 |
Second Address | Philadelphia, PA 19104-2640 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/06/2009 |
Last Update Date | 04/06/2009 |