Individual
MCKADE LUSK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
21260 N. 1450 E., MORONI, UT 84646-0383
(435) 851-6821
Mailing address
21260 N. 1450 E., MORONI, UT 84646-0383
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
Primary
—
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1
—
UT
Enumeration date
09/09/2013
Last updated
06/18/2015
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