Healthcare Provider Details

I. General information

NPI: 1083853352
Provider Name (Legal Business Name): KRISTA A LUSSIER FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/10/2009
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17300 N PERIMETER DR STE 220
SCOTTSDALE AZ
85255-6703
US

IV. Provider business mailing address

10200 GRAND CENTRAL AVE STE 220
OWINGS MILLS MD
21117-4366
US

V. Phone/Fax

Practice location:
  • Phone: 480-661-2661
  • Fax:
Mailing address:
  • Phone: 602-222-1900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP3229
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: