Provider Demographics
NPI:1639471311
Name:LUCKANISH, AMANDA FLORENCE (NP-C)
Entity type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:FLORENCE
Last Name:LUCKANISH
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:MS
Other - First Name:AMANDA
Other - Middle Name:FLORENCE
Other - Last Name:JOYCE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP-C
Mailing Address - Street 1:623 W NEWPORT PIKE
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19804-3235
Mailing Address - Country:US
Mailing Address - Phone:302-777-5473
Mailing Address - Fax:302-777-5483
Practice Address - Street 1:623 W NEWPORT PIKE
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19804-3235
Practice Address - Country:US
Practice Address - Phone:302-777-5473
Practice Address - Fax:302-777-5483
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-01
Last Update Date:2023-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DELG-0000520363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily