MEDICARE: TARA R. C. LUSSIER CD, RYT, CHHC

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	374J00000X	Doula		VA

General Provider Information

NPI Number	:	1508168931
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TARA R. C. LUSSIER CD, RYT, CHHC

Provider Business Mailing Address
First Line	:	503 MORRISETT CT SE
Second Line	:
City	:	LEESBURG
State	:	VA
Zip	:	20175-6140
Country	:	US
Telephone Number	:	703-472-4704
Fax Number	:

Provider Business Practice Location Address
First Line	:	503 MORRISETT CT SE
Second Line	:
City	:	LEESBURG
State	:	VA
Zip	:	20175-6140
Country	:	US
Telephone Number	:	703-472-4704
Fax Number	:

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

Provider Enumeration Date	:	11/17/2010
Last Update Date	:	11/17/2010

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