Provider Demographics
NPI:1164477485
Name:VIA, CAROL LUCAS (NP)
Entity Type:Individual
Prefix:MS
First Name:CAROL
Middle Name:LUCAS
Last Name:VIA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1970 ROANOKE BLVD
Mailing Address - Street 2:BUILDING # 12, ROOM 241
Mailing Address - City:SALEM
Mailing Address - State:VA
Mailing Address - Zip Code:24153-6404
Mailing Address - Country:US
Mailing Address - Phone:540-855-5000
Mailing Address - Fax:540-855-5012
Practice Address - Street 1:1970 ROANOKE BLVD
Practice Address - Street 2:BUILDING # 12, ROOM 241
Practice Address - City:SALEM
Practice Address - State:VA
Practice Address - Zip Code:24153-6404
Practice Address - Country:US
Practice Address - Phone:540-855-5000
Practice Address - Fax:540-855-5012
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2013-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024094429363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily