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General NPI Number Information
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NPI Number | 1548059769
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Entity Type | Individual
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Provider Name | KELLY ANNE LUSK
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Gender |
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Dates
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Enumeration Date | 05/05/2025
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Last Update Date | 05/21/2025
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Provider Practice Location Address
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Address Line | 303 EAST KEARSLEY STREET 4125 WILLIAM S. WHITE BUILDING
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City | FLINT
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State | MI
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Zip | 48502
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Country | US
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Telephone | 248-595-4916
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Fax |
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Provider Business Mailing Address
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Address Line | 27986 GAINES MILL WAY
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City | FARMINGTON HILLS
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State | MI
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Zip | 48331-3107
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Country | US
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Telephone |
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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 | 163WC0200X
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Taxonomy Name | Critical Care Medicine Registered Nurse
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License Number | 4704371979
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License Number State | MI
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