Provider Demographics
NPI:1801060017
Name:LUSSIER, CAROLYN ANNE
Entity type:Individual
Prefix:MRS
First Name:CAROLYN
Middle Name:ANNE
Last Name:LUSSIER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13312 OAK RIDGE LN
Mailing Address - Street 2:
Mailing Address - City:CHELSEA
Mailing Address - State:MI
Mailing Address - Zip Code:48118-9514
Mailing Address - Country:US
Mailing Address - Phone:734-475-6034
Mailing Address - Fax:
Practice Address - Street 1:13312 OAK RIDGE LN
Practice Address - Street 2:
Practice Address - City:CHELSEA
Practice Address - State:MI
Practice Address - Zip Code:48118-9514
Practice Address - Country:US
Practice Address - Phone:734-475-6034
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-17
Last Update Date:2008-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker