Provider Demographics
NPI:1063203875
Name:LUCAS-SHERROD, CORDELIA (RN)
Entity type:Individual
Prefix:
First Name:CORDELIA
Middle Name:
Last Name:LUCAS-SHERROD
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:CORDELIA
Other - Middle Name:
Other - Last Name:LUCAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:3705 SUMMERWALK RD
Mailing Address - Street 2:
Mailing Address - City:ROCKY MOUNT
Mailing Address - State:NC
Mailing Address - Zip Code:27804-8355
Mailing Address - Country:US
Mailing Address - Phone:252-904-4623
Mailing Address - Fax:
Practice Address - Street 1:3705 SUMMERWALK RD
Practice Address - Street 2:
Practice Address - City:ROCKY MOUNT
Practice Address - State:NC
Practice Address - Zip Code:27804-8355
Practice Address - Country:US
Practice Address - Phone:252-904-4623
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-13
Last Update Date:2025-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC146609163WX1500X, 163WW0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WW0000XNursing Service ProvidersRegistered NurseWound Care
No163WX1500XNursing Service ProvidersRegistered NurseOstomy Care