Healthcare Provider Details

I. General information

NPI: 1376323790
Provider Name (Legal Business Name): ANGELA LUSTER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ANGELA BROWN

II. Dates (important events)

Enumeration Date: 10/03/2023
Last Update Date: 10/03/2023
Certification Date: 10/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1420 E 125TH TER APT B
OLATHE KS
66061-5830
US

IV. Provider business mailing address

1420 E 125TH TER APT B
OLATHE KS
66061-5830
US

V. Phone/Fax

Practice location:
  • Phone: 913-704-7614
  • Fax:
Mailing address:
  • Phone: 913-704-7614
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: