Provider Demographics
NPI:1013477819
Name:LUCAS, AMY IRENE (MSN, RN, CCNS, CCRNK)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:IRENE
Last Name:LUCAS
Suffix:
Gender:F
Credentials:MSN, RN, CCNS, CCRNK
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:1906 BELLEVIEW AVE SE OFC
Mailing Address - Street 2:8W CNS OFFICE
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24014-1838
Mailing Address - Country:US
Mailing Address - Phone:540-224-2515
Mailing Address - Fax:
Practice Address - Street 1:1906 BELLEVIEW AVE SE OFC
Practice Address - Street 2:8W CNS OFFICE
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24014-1838
Practice Address - Country:US
Practice Address - Phone:540-224-2515
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-20
Last Update Date:2022-03-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0001159157163W00000X
VA015000969364SC0200X
VA0024181908364SC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SC0200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistCritical Care Medicine
No163W00000XNursing Service ProvidersRegistered Nurse