Jacquelyn Lusk
Individual provider Active NPI Licensed Practical Nurse · Holley, NY
NPI 1174944797 · NPPES record last updated Dec 27, 2013
Key facts
- NPI
- 1174944797
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Licensed Practical Nurse 164W00000X
- License
- 247778-1 (NY)
- Practice address
- 22A Mechanic St
Holley, NY 14470-1157 - Phone
- (585) 283-1124
- NPI assigned
- Dec 27, 2013
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 247778-1 | NY | MD | Licensed Practical Nurse |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Licensed Practical Nurse | 164W00000X | 247778-1 | NY | Yes |
Addresses
Primary practice location
22A Mechanic St
Holley, NY 14470-1157
Mailing address
22A Mechanic St
Holley, NY 14470-1157
Phone (585) 283-1124
Other providers in Holley, NY
- Sabir Khan
- Brittani Kinser
- Bruce J. Kowiak
- Anna Maria Laforce
- Lidia Levchuk
- Douglas Brian Lynch
- Gary Makas
- Rachelle Kay Mandigo
- Deborah Lynne Mercer-Ross
- Lucas J Miller
All providers in Holley, NY · Licensed Practical Nurse in New York
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 27, 2013. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.