# INTEGRATED WOUND CARE KENTUCKY PLLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1144970641
- **Authorized official:** DR. DIANE LUSAS MD (MEMBER)
- **Authorized official phone:** (718) 963-3495

## Contact information

- **Practice address:** 60 PHILLIPS BRANCH RD, PHELPS, KY 41553-9061
- **Practice address phone:** (718) 963-3495
- **Mailing address:** 492C CEDAR LN STE 514, TEANECK, NJ 07666-1713

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208D00000X | General Practice Physician | — | NULL | — |
| 208D00000X | General Practice Physician | — | — | — |
| 363LP2300X | Primary Care Nurse Practitioner | — | NULL | Yes |
| 363LP2300X | Primary Care Nurse Practitioner | — | — | Yes |

## Other

- **Enumeration date:** 03/27/2022
- **Last updated:** 12/29/2022