Provider Demographics
NPI:1093797565
Name:CUSHMAN, LISA J (MS, PHD)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:J
Last Name:CUSHMAN
Suffix:
Gender:F
Credentials:MS, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5662 PRIMROSE AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46220-3341
Mailing Address - Country:US
Mailing Address - Phone:317-465-0998
Mailing Address - Fax:
Practice Address - Street 1:975 W WALNUT ST
Practice Address - Street 2:IB 130
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-5181
Practice Address - Country:US
Practice Address - Phone:317-274-2450
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS