Provider Demographics
NPI:1376514166
Name:LUSCO, MELISSA Z (CRNA)
Entity Type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:Z
Last Name:LUSCO
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 661495
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35266-1495
Mailing Address - Country:US
Mailing Address - Phone:205-979-5882
Mailing Address - Fax:205-979-1248
Practice Address - Street 1:4950 ESSEN LN
Practice Address - Street 2:REGIONAL EYE SURGERY CENTER
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70809-3432
Practice Address - Country:US
Practice Address - Phone:225-214-6688
Practice Address - Fax:225-214-6687
Is Sole Proprietor?:No
Enumeration Date:2006-01-30
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP02818367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1687227Medicaid
LAP00409101OtherRR MEDICARE
LA5X011CT34Medicare PIN
LAS71412Medicare UPIN