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General NPI Number Information
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NPI Number | 1023582046
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Entity Type | Individual
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Provider Name | LAUREN ELIZABETH RUSY
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Gender | Female
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Dates
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Enumeration Date | 01/12/2019
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Last Update Date | 06/18/2020
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Provider Practice Location Address
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Address Line | 111 LIGHTHOUSE LN
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City | WINCHESTER
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State | VA
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Zip | 22602-6191
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Country | US
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Telephone | 512-619-0014
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Fax |
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Provider Business Mailing Address
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Address Line | 440 L ST NW UNIT 202
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City | WASHINGTON
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State | DC
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Zip | 20001-2569
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Country | US
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Telephone | 512-619-0014
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2086S0127X
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Taxonomy Name | Trauma Surgery Physician
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License Number | PA031736
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License Number State | DC
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