Provider Demographics
NPI:1114286325
Name:LUSCO, ANGELA RAE (RN, BSN)
Entity Type:Individual
Prefix:MS
First Name:ANGELA
Middle Name:RAE
Last Name:LUSCO
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26331 LAYCOCK CREEK RD
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:OR
Mailing Address - Zip Code:97865-6197
Mailing Address - Country:US
Mailing Address - Phone:541-620-2150
Mailing Address - Fax:541-575-3506
Practice Address - Street 1:725 W MAIN ST
Practice Address - Street 2:
Practice Address - City:JOHN DAY
Practice Address - State:OR
Practice Address - Zip Code:97845-1299
Practice Address - Country:US
Practice Address - Phone:541-620-2150
Practice Address - Fax:541-575-2910
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-08
Last Update Date:2012-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR09000577RN163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health