Provider Demographics
NPI:1689844136
Name:LUSK-FAUQUET, LINDA RENEE (ARNP)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:RENEE
Last Name:LUSK-FAUQUET
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18490 BALLINGER WAY NE
Mailing Address - Street 2:
Mailing Address - City:LAKE FOREST PARK
Mailing Address - State:WA
Mailing Address - Zip Code:98155-4239
Mailing Address - Country:US
Mailing Address - Phone:206-364-0174
Mailing Address - Fax:206-364-0174
Practice Address - Street 1:18490 BALLINGER WAY NE
Practice Address - Street 2:
Practice Address - City:LAKE FOREST PARK
Practice Address - State:WA
Practice Address - Zip Code:98155-4239
Practice Address - Country:US
Practice Address - Phone:206-364-0174
Practice Address - Fax:206-364-0174
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-11
Last Update Date:2008-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30002149163WG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0600XNursing Service ProvidersRegistered NurseGerontology