Individual
MISS MADELINE LUSK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1725 E BOULDER ST STE 101, COLORADO SPRINGS, CO 80909
(719) 365-6300
(719) 365-6094
Mailing address
2695 ROCKY MOUNTAIN AVE STE 150, LOVELAND, CO 80538-9071
(970) 624-4034
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA.0005909
CO
363AM0700X
Medical Physician Assistant
MA058586
PA
363AS0400X
Surgical Physician Assistant
MA058586
PA
Other
Enumeration date
10/06/2016
Last updated
08/06/2019
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