Healthcare Provider Details

I. General information

NPI: 1013477819
Provider Name (Legal Business Name): AMY IRENE LUCAS MSN, RN, CCNS, CCRNK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2019
Last Update Date: 03/11/2022
Certification Date: 03/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1906 BELLEVIEW AVE SE OFC 8W CNS OFFICE
ROANOKE VA
24014-1838
US

IV. Provider business mailing address

1906 BELLEVIEW AVE SE OFC 8W CNS OFFICE
ROANOKE VA
24014-1838
US

V. Phone/Fax

Practice location:
  • Phone: 540-224-2515
  • Fax:
Mailing address:
  • Phone: 540-224-2515
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code364SC0200X
TaxonomyCritical Care Medicine Clinical Nurse Specialist
License Number015000969
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code364SC0200X
TaxonomyCritical Care Medicine Clinical Nurse Specialist
License Number0024181908
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number0001159157
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: