Provider Demographics
NPI:1962259184
Name:LUSSIER, HEATHER JESSICA I (LPN)
Entity type:Individual
Prefix:MS
First Name:HEATHER
Middle Name:JESSICA
Last Name:LUSSIER
Suffix:I
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 N JAMES ST
Mailing Address - Street 2:
Mailing Address - City:CARTHAGE
Mailing Address - State:NY
Mailing Address - Zip Code:13619-1643
Mailing Address - Country:US
Mailing Address - Phone:315-405-6106
Mailing Address - Fax:
Practice Address - Street 1:17481 US ROUTE 11 LOT 10S
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:NY
Practice Address - Zip Code:13601-5352
Practice Address - Country:US
Practice Address - Phone:315-405-6106
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-06
Last Update Date:2024-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY28121701164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse