MEDICARE: DAVID LUSK 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	163W00000X	Registered Nurse	RN30138	NV

General Provider Information

NPI Number	:	1801061999
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID LUSK RN

Provider Business Mailing Address
First Line	:	2864 CORDILLERA DR
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89074-5736
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2455 W CHEYENNE AVE
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89032-4325
Country	:	US
Telephone Number	:	702-636-3000
Fax Number	:

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

Provider Enumeration Date	:	04/29/2008
Last Update Date	:	04/29/2008

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