MEDICARE: AMBERLY LYN LUCAS CNM

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	367A00000X	Advanced Practice Midwife	371625-4402	UT

General Provider Information

NPI Number	:	1760719389
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMBERLY LYN LUCAS CNM

Provider Business Mailing Address
First Line	:	3110 WEST 300 NORTH
Second Line	:	SUITE B
City	:	WEST POINT
State	:	UT
Zip	:	84015-7481
Country	:	US
Telephone Number	:	801-614-5270
Fax Number	:

Provider Business Practice Location Address
First Line	:	3110 WEST 300 NORTH
Second Line	:	SUITE B
City	:	WEST POINT
State	:	UT
Zip	:	84015-7481
Country	:	US
Telephone Number	:	801-614-5270
Fax Number	:

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

Provider Enumeration Date	:	11/04/2009
Last Update Date	:	11/04/2009

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