Provider Demographics
NPI:1336432533
Name:LUCAS, MONIQUE NICOLE (RN)
Entity type:Individual
Prefix:
First Name:MONIQUE
Middle Name:NICOLE
Last Name:LUCAS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10301 WINDTREE LN
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28215-9019
Mailing Address - Country:US
Mailing Address - Phone:443-326-6111
Mailing Address - Fax:
Practice Address - Street 1:11 UNION ST S STE 105
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28025-5088
Practice Address - Country:US
Practice Address - Phone:980-202-3500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-20
Last Update Date:2025-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC289597163WI0500X, 163WH0200X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
No163WI0500XNursing Service ProvidersRegistered NurseInfusion Therapy
No171M00000XOther Service ProvidersCase Manager/Care Coordinator