Provider Demographics
NPI:1619210333
Name:LUSHECK, JENNIFER A (CNP)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:A
Last Name:LUSHECK
Suffix:
Gender:F
Credentials:CNP
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 637676
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-7676
Mailing Address - Country:US
Mailing Address - Phone:513-561-6266
Mailing Address - Fax:513-561-0149
Practice Address - Street 1:7829 LAUREL AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45243-2608
Practice Address - Country:US
Practice Address - Phone:513-561-6266
Practice Address - Fax:513-561-0149
Is Sole Proprietor?:No
Enumeration Date:2013-04-01
Last Update Date:2013-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA.14367-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0082181Medicaid
OH0082181Medicaid