Provider Demographics
NPI:1932235876
Name:LUSSIER, SPICE A (NMD)
Entity Type:Individual
Prefix:
First Name:SPICE
Middle Name:A
Last Name:LUSSIER
Suffix:
Gender:F
Credentials:NMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9440 E IRONWOOD SQUARE DR
Mailing Address - Street 2:STE. 110
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85258-4569
Mailing Address - Country:US
Mailing Address - Phone:480-467-2167
Mailing Address - Fax:480-614-4477
Practice Address - Street 1:9440 E IRONWOOD SQUARE DR
Practice Address - Street 2:STE. 110
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-4569
Practice Address - Country:US
Practice Address - Phone:480-467-2167
Practice Address - Fax:480-614-4477
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ06-951175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath