Provider Demographics
NPI:1104137579
Name:LUSK, AMY LYNN (MS, RD, LD)
Entity type:Individual
Prefix:MRS
First Name:AMY
Middle Name:LYNN
Last Name:LUSK
Suffix:
Gender:F
Credentials:MS, RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8628 CLOVER GLADE DR
Mailing Address - Street 2:
Mailing Address - City:LEWIS CENTER
Mailing Address - State:OH
Mailing Address - Zip Code:43035-8649
Mailing Address - Country:US
Mailing Address - Phone:740-703-7743
Mailing Address - Fax:
Practice Address - Street 1:171 GREEN MEADOWS DR S
Practice Address - Street 2:
Practice Address - City:LEWIS CENTER
Practice Address - State:OH
Practice Address - Zip Code:43035-9458
Practice Address - Country:US
Practice Address - Phone:614-985-6569
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-30
Last Update Date:2010-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH85002283133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered