MEDICARE: MRS. AMANDA FLORENCE LUCKANISH NP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	LG-0000520	DE

General Provider Information

NPI Number	:	1639471311
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. AMANDA FLORENCE LUCKANISH NP-C

Provider Business Mailing Address
First Line	:	623 W NEWPORT PIKE
Second Line	:
City	:	WILMINGTON
State	:	DE
Zip	:	19804-3235
Country	:	US
Telephone Number	:	302-777-5473
Fax Number	:	302-777-5483

Provider Business Practice Location Address
First Line	:	623 W NEWPORT PIKE
Second Line	:
City	:	WILMINGTON
State	:	DE
Zip	:	19804-3235
Country	:	US
Telephone Number	:	302-777-5473
Fax Number	:	302-777-5483

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/01/2010
Last Update Date	:	10/06/2023

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