Provider Demographics
NPI:1639548076
Name:LUCAS, SAMANTHA ANN (PMH-NP)
Entity Type:Individual
Prefix:MS
First Name:SAMANTHA
Middle Name:ANN
Last Name:LUCAS
Suffix:
Gender:F
Credentials:PMH-NP
Other - Prefix:
Other - First Name:SAMANTHA
Other - Middle Name:ANN
Other - Last Name:SPONSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1138
Mailing Address - Street 2:
Mailing Address - City:FISHERSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22939-1138
Mailing Address - Country:US
Mailing Address - Phone:540-688-2646
Mailing Address - Fax:
Practice Address - Street 1:9 PINNACLE DR
Practice Address - Street 2:
Practice Address - City:FISHERSVILLE
Practice Address - State:VA
Practice Address - Zip Code:22939-2366
Practice Address - Country:US
Practice Address - Phone:540-688-2646
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-16
Last Update Date:2015-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024172852363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health