Healthcare Provider Details

I. General information

NPI: 1972557981
Provider Name (Legal Business Name): LUREE LUSK ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/22/2006
Last Update Date: 10/17/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1919 N AMIDON AVE STE.100
WICHITA KS
67203-2117
US

IV. Provider business mailing address

934 N WATER ST
WICHITA KS
67203-3838
US

V. Phone/Fax

Practice location:
  • Phone: 316-660-7540
  • Fax: 316-660-7488
Mailing address:
  • Phone: 316-660-7621
  • Fax: 316-941-5075

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number13-54154-032
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number74452
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: