Provider Demographics
NPI:1043653884
Name:LUCAS, HEIDI JO (RD, LDN)
Entity type:Individual
Prefix:
First Name:HEIDI
Middle Name:JO
Last Name:LUCAS
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:138 ROLAND AVE
Mailing Address - Street 2:
Mailing Address - City:CHAMBERSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17201-1444
Mailing Address - Country:US
Mailing Address - Phone:717-372-6687
Mailing Address - Fax:717-446-0033
Practice Address - Street 1:35 RAGGED EDGE ROAD
Practice Address - Street 2:
Practice Address - City:CHAMBERSBURG
Practice Address - State:PA
Practice Address - Zip Code:17202
Practice Address - Country:US
Practice Address - Phone:717-372-6687
Practice Address - Fax:717-446-0033
Is Sole Proprietor?:No
Enumeration Date:2013-04-11
Last Update Date:2016-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN001186133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered