Provider Demographics
NPI:1396083002
Name:LUSTER-SMITH, MARSHA FAYE (FNP)
Entity type:Individual
Prefix:MRS
First Name:MARSHA
Middle Name:FAYE
Last Name:LUSTER-SMITH
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:939 GAY AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63130-2737
Mailing Address - Country:US
Mailing Address - Phone:314-721-3746
Mailing Address - Fax:
Practice Address - Street 1:939 GAY AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63130-2737
Practice Address - Country:US
Practice Address - Phone:314-721-3746
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-30
Last Update Date:2013-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2012036462363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily