Provider Demographics
NPI:1942225818
Name:LUSK, PATRICIA L (CRNA)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:L
Last Name:LUSK
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 1:3204 VIRGINIA AVENUE
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25304-3204
Mailing Address - Country:US
Mailing Address - Phone:304-342-7878
Mailing Address - Fax:
Practice Address - Street 1:3204 VIRGINIA AVE SE
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25304-1208
Practice Address - Country:US
Practice Address - Phone:304-342-7878
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2011-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV55630367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVA00248Medicare UPIN