| NPI | 1154830123 |
|---|---|
| Former Name | CARLY JORDAN LUCAS |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: IN 71008097A) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: KY 3011680) |
| Enumeration Date | 2017-09-21 |
| Last Update Date | 2022-11-15 |