Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | 170924 | NC |
Y | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | 17709A | SC |
NPI | 1245482827 |
---|---|
Provider Name | Mrs. Katherine Lucas |
First Address | Charlotte, NC 28275-1461 |
Second Address | Charleston, SC 29425-8908 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/10/2008 |
Last Update Date | 10/02/2012 |