Organization
INTEGRATED WOUND CARE KENTUCKY PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DIANE LUSAS MD (MEMBER)
(718) 963-3495
Entity
Organization
Contact information
Practice address
60 PHILLIPS BRANCH RD, PHELPS, KY 41553-9061
(718) 963-3495
Mailing address
492C CEDAR LN STE 514, TEANECK, NJ 07666-1713
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
—
—
363LP2300X
Primary Care Nurse Practitioner
Primary
—
—
Other
Enumeration date
03/27/2022
Last updated
12/29/2022
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