Provider Demographics
NPI:1396895108
Name:LUSH, JENNIFER AMY (ND)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:AMY
Last Name:LUSH
Suffix:
Gender:F
Credentials:ND
Other - Prefix:DR
Other - First Name:JENNIFER
Other - Middle Name:AMY
Other - Last Name:LUSH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:ND
Mailing Address - Street 1:915 W NORTHERN LIGHTS BLVD
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99503-2408
Mailing Address - Country:US
Mailing Address - Phone:907-770-9700
Mailing Address - Fax:
Practice Address - Street 1:915 W NORTHERN LIGHTS BLVD
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503-2408
Practice Address - Country:US
Practice Address - Phone:907-770-9700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK57175F00000X
WA1086175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath