Provider Demographics
NPI:1760719389
Name:LUCAS, AMBERLY LYN (CNM)
Entity Type:Individual
Prefix:
First Name:AMBERLY
Middle Name:LYN
Last Name:LUCAS
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3110 WEST 300 NORTH
Mailing Address - Street 2:SUITE B
Mailing Address - City:WEST POINT
Mailing Address - State:UT
Mailing Address - Zip Code:84015-7481
Mailing Address - Country:US
Mailing Address - Phone:801-614-5270
Mailing Address - Fax:
Practice Address - Street 1:3110 WEST 300 NORTH
Practice Address - Street 2:SUITE B
Practice Address - City:WEST POINT
Practice Address - State:UT
Practice Address - Zip Code:84015-7481
Practice Address - Country:US
Practice Address - Phone:801-614-5270
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-11-04
Last Update Date:2009-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT371625-4402367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife