# MRS. AMANDA REBECCA LUCKE

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1003083684
- **Gender:** F

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363L00000X | Nurse Practitioner | 71002639A | IN | Yes |

## Other

- **Enumeration date:** 05/13/2008
- **Last updated:** 10/30/2023

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 200921940 | — | IN |
| 01 | — | IN1125030 | MEDICARE PTAN | IN |
| 01 | — | IN1126018 | MEDICARE PTAN | IN |