Provider Demographics
NPI:1679027247
Name:LUCAS, ADEKUNBI (APRN, FNP)
Entity type:Individual
Prefix:
First Name:ADEKUNBI
Middle Name:
Last Name:LUCAS
Suffix:
Gender:F
Credentials:APRN, FNP
Other - Prefix:
Other - First Name:ADEKUNBI
Other - Middle Name:
Other - Last Name:COSTA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN, FNP
Mailing Address - Street 1:835 S WOLCOTT AVE
Mailing Address - Street 2:ROOM E-270
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612
Mailing Address - Country:US
Mailing Address - Phone:312-996-5197
Mailing Address - Fax:
Practice Address - Street 1:835 S WOLCOTT AVE
Practice Address - Street 2:ROOM E-270
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612
Practice Address - Country:US
Practice Address - Phone:312-996-5197
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-11
Last Update Date:2021-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209013869363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily