Individual
MRS. TINA MARIE LUSK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
22667 PICO ST, GRAND TERRACE, CA 92313-5723
(909) 514-1013
Mailing address
22667 PICO ST, GRAND TERRACE, CA 92313-5723
(909) 514-1013
Taxonomy
Speciality
Code
Description
License number
State
163WN0002X
Neonatal Intensive Care Registered Nurse
Primary
540788
CA
Other
Enumeration date
05/10/2012
Last updated
05/10/2012
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