Provider Demographics
NPI:1801455753
Name:LANCASTER-BUSSEY, DESIREE (REGISTERED NURSE)
Entity type:Individual
Prefix:
First Name:DESIREE
Middle Name:
Last Name:LANCASTER-BUSSEY
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:126 N CEDAR AVE
Mailing Address - Street 2:
Mailing Address - City:HENRICO
Mailing Address - State:VA
Mailing Address - Zip Code:23075-1429
Mailing Address - Country:US
Mailing Address - Phone:804-999-1719
Mailing Address - Fax:
Practice Address - Street 1:126 N CEDAR AVE
Practice Address - Street 2:
Practice Address - City:HENRICO
Practice Address - State:VA
Practice Address - Zip Code:23075-1429
Practice Address - Country:US
Practice Address - Phone:804-999-1719
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-12
Last Update Date:2019-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001246692163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse