Provider Demographics
NPI:1043105638
Name:LUSH MEDICAL AESTHETICS
Entity type:Organization
Organization Name:LUSH MEDICAL AESTHETICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:
Authorized Official - Last Name:SANNE
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:406-560-0878
Mailing Address - Street 1:7536 TELLURIDE DR
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82009-8921
Mailing Address - Country:US
Mailing Address - Phone:406-560-0878
Mailing Address - Fax:
Practice Address - Street 1:307 W LINCOLNWAY
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82001-4437
Practice Address - Country:US
Practice Address - Phone:307-630-4191
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-06-12
Last Update Date:2025-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty