Provider Demographics
NPI:1871774869
Name:LUCAS, LISA LYNN (RN)
Entity type:Individual
Prefix:MS
First Name:LISA
Middle Name:LYNN
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 1:756 SILVER SANDS DR
Mailing Address - Street 2:
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38018-3583
Mailing Address - Country:US
Mailing Address - Phone:901-624-0825
Mailing Address - Fax:
Practice Address - Street 1:1060 JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38104-9411
Practice Address - Country:US
Practice Address - Phone:901-544-1060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-18
Last Update Date:2008-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRN0000137590163W00000X
ARCO2698367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse