Healthcare Provider Details

I. General information

NPI: 1063203875
Provider Name (Legal Business Name): CORDELIA LUCAS-SHERROD RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CORDELIA LUCAS RN

II. Dates (important events)

Enumeration Date: 05/13/2025
Last Update Date: 05/13/2025
Certification Date: 05/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3705 SUMMERWALK RD
ROCKY MOUNT NC
27804-8355
US

IV. Provider business mailing address

3705 SUMMERWALK RD
ROCKY MOUNT NC
27804-8355
US

V. Phone/Fax

Practice location:
  • Phone: 252-904-4623
  • Fax:
Mailing address:
  • Phone: 252-904-4623
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WX1500X
TaxonomyOstomy Care Registered Nurse
License Number146609
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code163WW0000X
TaxonomyWound Care Registered Nurse
License Number146609
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: