Provider Demographics
NPI:1730760125
Name:LUSE, LISA
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:LUSE
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 1:1878 QUEEN ELIZABETH DR
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:OH
Mailing Address - Zip Code:43130-1194
Mailing Address - Country:US
Mailing Address - Phone:740-475-7931
Mailing Address - Fax:
Practice Address - Street 1:1878 QUEEN ELIZABETH DR
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:OH
Practice Address - Zip Code:43130-1194
Practice Address - Country:US
Practice Address - Phone:740-475-7931
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-16
Last Update Date:2021-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant