Basic Information
Provider Information
NPI: 1003002957
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: LUCAS
FirstName: SUZANNE
MiddleName:  
NamePrefix: MS.
NameSuffix:  
Credential: L.AC.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 12821 N CAVE CREEK RD
Address2: SUITE 101
City: PHOENIX
State: AZ
PostalCode: 850225862
CountryCode: US
TelephoneNumber: 6024048483
FaxNumber: 6024932246
Practice Location
Address1: 12821 N CAVE CREEK RD
Address2: SUITE 101
City: PHOENIX
State: AZ
PostalCode: 850225862
CountryCode: US
TelephoneNumber: 6024048483
FaxNumber: 6024932246
Other Information
ProviderEnumerationDate: 09/24/2007
LastUpdateDate: 09/24/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
171100000X0192AZY Other Service ProvidersAcupuncturist 

No ID Information.


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