Provider Demographics
NPI:1447280953
Name:LUCAS, MARY LONOGAN (RN BSN)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:LONOGAN
Last Name:LUCAS
Suffix:
Gender:F
Credentials:RN BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2965 MUNICIPAL WAY
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32304
Mailing Address - Country:US
Mailing Address - Phone:850-487-3186
Mailing Address - Fax:850-487-7954
Practice Address - Street 1:2965 MUNICIPAL WAY
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32304
Practice Address - Country:US
Practice Address - Phone:850-487-3186
Practice Address - Fax:850-487-7954
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9235099RN163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health