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General NPI Number Information
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NPI Number | 1942225818
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Entity Type | Individual
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Provider Name | PATRICIA L LUSK CRNA
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Gender | Female
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Dates
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Enumeration Date | 07/13/2006
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Last Update Date | 08/02/2011
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Provider Practice Location Address
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Address Line | 3204 VIRGINIA AVE SE
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City | CHARLESTON
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State | WV
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Zip | 25304-1208
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Country | US
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Telephone | 304-342-7878
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Fax |
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Provider Business Mailing Address
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Address Line | 3204 VIRGINIA AVENUE
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City | CHARLESTON
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State | WV
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Zip | 25304-3204
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Country | US
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Telephone | 304-342-7878
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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 | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 55630
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License Number State | WV
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