Provider Demographics
NPI:1629157029
Name:CUSKER, CARRIE (LPN)
Entity Type:Individual
Prefix:MS
First Name:CARRIE
Middle Name:
Last Name:CUSKER
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13323 EAGLE HARBOR KNOWLESVILLE RD
Mailing Address - Street 2:
Mailing Address - City:ALBION
Mailing Address - State:NY
Mailing Address - Zip Code:14411-9135
Mailing Address - Country:US
Mailing Address - Phone:585-944-1555
Mailing Address - Fax:
Practice Address - Street 1:13323 EAGLE HARBOR KNOWLESVILLE RD
Practice Address - Street 2:
Practice Address - City:ALBION
Practice Address - State:NY
Practice Address - Zip Code:14411-9135
Practice Address - Country:US
Practice Address - Phone:585-944-1555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-04
Last Update Date:2012-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY247767-1164W00000X
NY012488225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02390581Medicaid