Provider Demographics
NPI:1033430426
Name:RUSK, LINDSEY ANNE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:LINDSEY
Middle Name:ANNE
Last Name:RUSK
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:LINDSEY
Other - Middle Name:A
Other - Last Name:WEISS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:1 MEDICAL CENTER BLVD
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27157-0447
Mailing Address - Country:US
Mailing Address - Phone:336-716-0209
Mailing Address - Fax:336-716-0030
Practice Address - Street 1:MEDICAL CENTER BLVD
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27157-9875
Practice Address - Country:US
Practice Address - Phone:336-716-0209
Practice Address - Fax:336-716-0030
Is Sole Proprietor?:No
Enumeration Date:2010-06-19
Last Update Date:2019-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD363AM0700X
NC0010-04543363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical