Provider Demographics
NPI:1487826301
Name:CRUISE, LESTER DEAN (RN, ANP-C)
Entity Type:Individual
Prefix:MR
First Name:LESTER
Middle Name:DEAN
Last Name:CRUISE
Suffix:
Gender:M
Credentials:RN, ANP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6827 FORDWICK DR
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23518-4938
Mailing Address - Country:US
Mailing Address - Phone:757-441-6320
Mailing Address - Fax:757-441-3760
Practice Address - Street 1:439 W YORK ST
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23510-1114
Practice Address - Country:US
Practice Address - Phone:757-441-6320
Practice Address - Fax:757-441-3760
Is Sole Proprietor?:No
Enumeration Date:2008-04-01
Last Update Date:2008-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC149859363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health