Individual
JUSTIN ROBERT CUSICK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
8990 SPRINGBROOK DR NW STE 250, COON RAPIDS, MN 55433-5884
(763) 398-1176
Mailing address
3514 CHERRY LN UNIT A, WOODBURY, MN 55129-8794
(651) 335-1665
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
R160593-8
MN
367500000X
Certified Registered Nurse Anesthetist
091716
MN
Other
Enumeration date
09/30/2012
Last updated
09/30/2012
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