Provider Demographics
NPI:1104854694
Name:LUSK, PAMELA (NP)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:
Last Name:LUSK
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:718 SOLANO DR
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86301-1520
Mailing Address - Country:US
Mailing Address - Phone:928-830-7530
Mailing Address - Fax:
Practice Address - Street 1:500 N 3RD ST # MC2104
Practice Address - Street 2:NP HEALTHCARE- DOWNTOWN PHOENIX CAMPUS
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85004-2135
Practice Address - Country:US
Practice Address - Phone:602-496-0721
Practice Address - Fax:602-496-0675
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2021-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN054820363LP0808X
AZAP1313363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ953358Medicaid
AZ106288Medicare PIN
AZ953358Medicaid