Individual
AVONNA LUSK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4018 N 67TH AVE, PHOENIX, AZ 85033-4028
(623) 849-8511
Mailing address
4018 N 67TH AVE, PHOENIX, AZ 85033-4028
(623) 849-8511
Taxonomy
Speciality
Code
Description
License number
State
163WS0200X
School Registered Nurse
Primary
236019
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
D07919809
N/A
—
Enumeration date
02/16/2023
Last updated
02/16/2023
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