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Individual
MRS. AMANDA REBECCA LUCKE
Active
Individual
MRS. AMANDA REBECCA LUCKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
71002639A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200921940
—
IN
01
—
IN1125030
MEDICARE PTAN
IN
01
—
IN1126018
MEDICARE PTAN
IN
Enumeration date
05/13/2008
Last updated
10/30/2023
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