Provider Demographics
NPI:1043548522
Name:LUCAS, PATRICIA FALLON (NP)
Entity type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:FALLON
Last Name:LUCAS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 GROVE ST
Mailing Address - Street 2:
Mailing Address - City:HERNDON
Mailing Address - State:VA
Mailing Address - Zip Code:20170-4735
Mailing Address - Country:US
Mailing Address - Phone:703-620-4294
Mailing Address - Fax:
Practice Address - Street 1:500 GROVE ST
Practice Address - Street 2:
Practice Address - City:HERNDON
Practice Address - State:VA
Practice Address - Zip Code:20170-4735
Practice Address - Country:US
Practice Address - Phone:703-620-4294
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-11-23
Last Update Date:2009-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001189462363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily