Provider Demographics
NPI:1750702833
Name:WHITESIDE-LUCAS, HATTIE MAE
Entity type:Individual
Prefix:MRS
First Name:HATTIE
Middle Name:MAE
Last Name:WHITESIDE-LUCAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:613 N YUKON AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74127-5224
Mailing Address - Country:US
Mailing Address - Phone:918-406-7766
Mailing Address - Fax:918-582-1663
Practice Address - Street 1:613 N YUKON AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74127-5224
Practice Address - Country:US
Practice Address - Phone:918-406-7766
Practice Address - Fax:918-582-1663
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-17
Last Update Date:2013-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker