Individual
LAWRENCE LUSAKA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
21550 PROVINCIAL BLVD, KATY, TX 77450-7560
(346) 978-2007
Mailing address
21550 PROVINCIAL BLVD #1611, KATY, KATY, TX 77450
(346) 978-2007
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
974527
TX
Other
Enumeration date
08/06/2019
Last updated
08/06/2019
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