MEDICARE: EDAN LUSCHEI RN

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	163WS0200X	School Registered Nurse	R31407	NM

General Provider Information

NPI Number	:	1790107688
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EDAN LUSCHEI RN

Provider Business Mailing Address
First Line	:	637 N ARMIJO ST
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88005-2120
Country	:	US
Telephone Number	:	575-527-9430
Fax Number	:	575-527-9444

Provider Business Practice Location Address
First Line	:	5700 MESA GRANDE DR
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88011-6017
Country	:	US
Telephone Number	:	575-527-9430
Fax Number	:	575-571-9444

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

Provider Enumeration Date	:	01/10/2014
Last Update Date	:	01/10/2014

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