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General NPI Number Information
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NPI Number | 1043105638
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Entity Type | Organization
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Legal Business Name | LUSH MEDICAL AESTHETICS
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Dates
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Enumeration Date | 06/12/2025
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Last Update Date | 06/12/2025
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Provider Practice Location Address
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Address Line | 307 W LINCOLNWAY
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City | CHEYENNE
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State | WY
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Zip | 82001-4437
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Country | US
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Telephone | 307-630-4191
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Fax |
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Provider Business Mailing Address
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Address Line | 7536 TELLURIDE DR
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City | CHEYENNE
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State | WY
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Zip | 82009-8921
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Country | US
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Telephone | 406-560-0878
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KATHERINE SANNE
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Credential | APRN
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Telephone | 406-560-0878
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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