Basic Information
| Provider Information | |||||||||
| NPI: | 1952496135 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LUCAS | ||||||||
| FirstName: | MELISSA | ||||||||
| MiddleName: | A | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | CRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 47 RIVER ST | ||||||||
| Address2: | |||||||||
| City: | FORTY FORT | ||||||||
| State: | PA | ||||||||
| PostalCode: | 187045034 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2029979186 | ||||||||
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| Practice Location | |||||||||
| Address1: | 500 HOSPITAL DR | ||||||||
| Address2: | |||||||||
| City: | WARRENTON | ||||||||
| State: | VA | ||||||||
| PostalCode: | 201863027 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7032959360 | ||||||||
| FaxNumber: | 7032959369 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/04/2006 | ||||||||
| LastUpdateDate: | 07/09/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | 0024166199 | VA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
ID Information
| ID | Type | State | Issuer | Description | 010200211 | 05 | VA | MEDICAID | K142-0002 | 01 | VA | CARE FIRST 2005 | OTHER | 010196744 | 05 | VA | MEDICAID | 484645 | 01 | VA | NCPPO | OTHER | P00247369 | 01 | VA | RAILROAD MEDICARE | OTHER | 010196442 | 05 | VA | MEDICAID | 139230 | 01 | VA | TRIGON | OTHER |