MEDICARE: MARCIE DIANNE LUSK DNP, APRN, FNP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	AP118280	TX

General Provider Information

NPI Number	:	1699009001
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARCIE DIANNE LUSK DNP, APRN, FNP-C

Provider Business Mailing Address
First Line	:	PO BOX 22000
Second Line	:
City	:	SAN ANGELO
State	:	TX
Zip	:	76902-7200
Country	:	US
Telephone Number	:	325-747-1511
Fax Number	:

Provider Business Practice Location Address
First Line	:	2503 S GREGG ST STE C
Second Line	:
City	:	BIG SPRING
State	:	TX
Zip	:	79720-6583
Country	:	US
Telephone Number	:	432-606-5178
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/01/2009
Last Update Date	:	02/14/2024

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